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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601783
Report Date: 11/30/2023
Date Signed: 11/30/2023 06:34:18 PM

Document Has Been Signed on 11/30/2023 06:34 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:AIM HIGHER INCFACILITY NUMBER:
198601783
ADMINISTRATOR:GABRIELLA BRANDFACILITY TYPE:
775
ADDRESS:1751 ROWLAND AVENUETELEPHONE:
(626) 332-2357
CITY:WEST COVINASTATE: CAZIP CODE:
91791
CAPACITY: 70CENSUS: 53DATE:
11/30/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:22 PM
MET WITH:Gabriella BrandTIME COMPLETED:
05:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required Visit on 11/30/2023. LPA was met by Administrator Brand and explained the purpose of the visit. Facility is licensed to serve 70 adults over the age of 18of which 10 adults may be non-ambulatory. Facility serves an adult day program and currently is still serving clients virtually and in person due to COVID 19. Facility has a lobby, a conference room, exercise room, life skill room, volunteer room, outing room, media room, vocational room, changing room/relaxation room, program director office, administration office, staff break room/kitchen, two (2) female bathrooms and two (2) male bathrooms.

LPA conducted a tour of the facility with the director and observed the following:
Restroom water temperature were measured between 105-120 degrees F. Facility has a fire sprinkler system, and five (5) fire extinguishers were observed throughout the facility. Restrooms were observed to be clean and well maintained. Restrooms contained grab bars near toilets. Clients usually bring their own lunch and snacks. Cleaning supplies are stored in a locked cabinet in facility conference room. The facility has two (2) first aid kits and were observed to be in the program director’s office. Facility walkways were observed to clear of hazards. Outing room was observed to be missing two (2) tiles in the ceiling. Six (6) staff files were reviewed.

One deficiency was observed. Exit interview conducted with Administrator Brand and a copy of this report, 809-D and appeals rights was provided.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2023
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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Document Has Been Signed on 11/30/2023 06:34 PM - It Cannot Be Edited


Created By: Kimberly Ramirez On 11/30/2023 at 04:21 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: AIM HIGHER INC
FACILITY NUMBER: 198601783

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/30/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82087(a)
Buildings and Grounds
(a) The program site shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, two ceiling tiles were missing from Outing room, the licensee did not comply with the section cited above in 53 out of 53 clients, and/or staff, and visitors, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/14/2023
Plan of Correction
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Licensee will submit photo proof of repair via email and invoice of repair by 12/14/23.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Tony Vasallo
LICENSING EVALUATOR NAME:Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:
DATE: 11/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/30/2023


LIC809 (FAS) - (06/04)
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