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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209176
Report Date: 04/18/2023
Date Signed: 04/18/2023 12:27:09 PM

Document Has Been Signed on 04/18/2023 12:27 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:AIMES MEACHAMFACILITY NUMBER:
157209176
ADMINISTRATOR:GROUNDS, TIFFANYFACILITY TYPE:
737
ADDRESS:14405 MEACHAM ROADTELEPHONE:
(661) 589-9992
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93314
CAPACITY: 3CENSUS: 3DATE:
04/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:41 AM
MET WITH:Administrator, Tiffany Grounds and Administrative Social Worker, Macy VarnerTIME COMPLETED:
12:40 PM
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On 04/18/2023, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct an annual inspection. LPA introduced self and was granted entry to the facility by Administrator. LPA disclosed the purpose of the visit to Administrator. There are no clients present during today's visit. LPA met with Administrator, Tiffany Grounds (AD) and Administrative Social Worker, Macy Varner (ASW).

LPA conducted a tour of the facility with AD and ASW. During today's inspection the facility was odor free, at a comfortable temperature, and all pathways were clear from obstructions. Common areas were furnished and had adequate seating and lighting available. Resident bedrooms toured. Bedrooms had all required furnishings and adequate lighting. Resident bathrooms toured. Hot water measured at 114.2 degrees F. in bathroom 1 and 117.6 degrees F. in bathroom 2. Facility kitchen toured. Facility kitchen appeared to be clean and safe for food preparation. LPA observed a 2-day supply of perishable foods and a 7-day supply of non-perishable foods.

Exterior tour conducted. Exterior exits were open and free of obstructions during today's visit. Fire extinguisher was last served on 09/28/2022. Smoke detector and carbon monoxide detector observed to be operational during today's visit. Facility conducted a fire drill on 04/12/2023. Cleaning supplies are secure and inaccessible to clients in the garage. Medications and sharps are locked and inaccessible in the facility medication room. LPA reviewed staff and client records. Medications were observed to be administered as prescribed.

LPA is requesting the following documents be submitted to the Fresno CCL office by 05/03/2023: Current copy of Administrator Certificate, Designation of Facility Responsibility, Administrator Organization, Affidavit regarding Client/Resident Cash Resources, Emergency and Disaster, Plan Personnel Report, Register of Facility Clients/Residents, Surety Bond

No deficiencies issued during this inspection. A copy of this report was discussed and provided to Administrator, Tiffany Grounds, whose signature on this form confirms receipt of this document.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 04/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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