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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209184
Report Date: 02/06/2023
Date Signed: 02/06/2023 12:45:25 PM

Document Has Been Signed on 02/06/2023 12:45 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 PACINIFACILITY NUMBER:
157209184
ADMINISTRATOR:THOMAS, TATIANNAFACILITY TYPE:
737
ADDRESS:2700 PACINI STREETTELEPHONE:
(661) 589-9992
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93314
CAPACITY: 3CENSUS: 2DATE:
02/06/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:56 AM
MET WITH:Facility Staff, Macy VarnerTIME COMPLETED:
12:59 PM
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On 02/06/2023, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct an case management visit. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. Administrator, Tatianna Thomas is not available to attend this visit. LPA met with with Facility Staff, Macy Varner and Operations Manager, Alexis Rutledge via telephone.

The purpose of today's visit is follow up on an incident reported to the Fresno CCL office on 02/06/2023. During today's visit, LPA interviewed staff and reviewed records for R1.

No deficiencies issued.

A copy of this report was discussed and provided to Facility Staff, Macy Varner, whose signature on this form confirms receipt of this document.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2023
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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