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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 317003286
Report Date: 07/12/2023
Date Signed: 07/12/2023 10:16:37 AM

Document Has Been Signed on 07/12/2023 10:16 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:AIM HIGHER INC. DBA ED DAVIDFACILITY NUMBER:
317003286
ADMINISTRATOR:DAVID, EDFACILITY TYPE:
775
ADDRESS:1132 SMITH LANETELEPHONE:
(916) 783-4688
CITY:ROSEVILLESTATE: CAZIP CODE:
95661
CAPACITY: 136CENSUS: 58DATE:
07/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Melissa Sipsy- Administrator TIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility unannounced on 07/12/2023 to conduct a Required-1 Year Inspection utilizing the Inspection Tool. LPA met with Administrator, Melissa Sipsy, and explained the purpose of the visit.

At 9:00 AM, LPA toured the interior and exterior of the facility together with Administrator to ensure health and safety of clients in care. Areas toured include but are not limited to: common areas, four (4) multipurpose rooms, three (3) bathrooms, kitchen, and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA observed required furniture, and lighting throughout the facility. LPA observed residents' bathrooms to be clean, sanitary, and in good repair. The hot water temperature was measured in the kitchen at 110 degrees Fahrenheit. First aid kit was completed. LPA observed fire detectors and carbon monoxide alarms to be operable. The fire extinguisher was last serviced on 07/02/2023.

At 9:20 AM, LPA reviewed a total of three (3) client files. Resident files contain admission agreements, physician's reports, IPP, identification sheets, releases, and resident's rights. LPA reviewed a total of three (3) staff record. Staff has training Title 17, Title 22, first aid and CPR, and other various areas of care provision.

No deficiencies are being cited as a result of todays inspection.

Exit interview conducted and copy of report left at the facility.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Sarena Keosavang
LICENSING EVALUATOR SIGNATURE: DATE: 07/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/12/2023
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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