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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209184
Report Date: 06/19/2023
Date Signed: 06/19/2023 01:00:23 PM

Document Has Been Signed on 06/19/2023 01:00 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:RUTLEDGE, ALEXISFACILITY TYPE:
737
ADDRESS:2700 PACINI STREETTELEPHONE:
(661) 589-9992
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93314
CAPACITY: 3CENSUS: 3DATE:
06/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:11 AM
MET WITH:Administrator, Sean Battle and Administrator, Alexis RutledgeTIME COMPLETED:
12:21 PM
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On 06/19/2023, Licensing Program Analyst (LPA) Walton arrived at the facility unannounced to conduct an Annual Required Inspection. LPA introduced self and stated the purpose of the visit and was allowed to enter the facility. LPA met with Administrators, Alexis Rutledge and Sean Battle

There is one resident present during the inspection. Residents was observed to be sleeping.

LPA conducted a tour of the facility with Administrators. During the inspection the facility appeared clean and odor free and at a comfortable temperature. Common areas were furnished and had adequate seating and lighting available. Resident bedrooms appeared clean and had required furnishings and adequate lighting. Residents bathrooms appeared clean, water temperature measured at 114.6 degrees F. Facility kitchen appeared to be clean and safe for food preparation. Food supply was checked.

Exterior tour conducted, all exits open and free of obstructions on today’s visit. Facility swimming pool was inaccessible to residents in care surrounded by a fence. Fire extinguisher is current with a service date 10/14/2022. Last fire drill conducted on 06/16/2023. Cleaning supplies observed to be locked in a cabinet in the garage. LPA reviewed client and staff files. Medications observed to be administered as prescribed.

LPA is requesting the following documents be submitted to the Fresno CCL office by 07/03/2023: 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 today's inspection.

Exit interview conducted. A copy of this report was discussed and provided to the Administrator whose signature on this form confirms receipt of this document.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 06/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/19/2023
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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