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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004282
Report Date: 12/09/2024
Date Signed: 12/09/2024 01:35:39 PM

Document Has Been Signed on 12/09/2024 01:35 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:AIM HIGHER INC.FACILITY NUMBER:
347004282
ADMINISTRATOR/
DIRECTOR:		VEAN LOEUNFACILITY TYPE:
775
ADDRESS:3151 DWIGHT ROAD, SUITE 300TELEPHONE:
(916) 391-4668
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 30CENSUS: 24DATE:
12/09/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Vean LoeunTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to conduct an annual inspection. LPA Moleski met with director Vean Loeun and explained the purpose of the visit.

LPA Moleski reviewed five client files (C1-C5) and five staff files (S1-S5).

LPA Moleski toured the facility with Loeun and inspected common areas, the kitchen, and bathrooms. Furniture and furnishings were sufficient to meet the needs of residents. LPA Moleski observed a fully-charged and up-to-date fire extinguisher, and working carbon monoxide/smoke detectors. LPA Moleski observed a locked cabinet for the storage of medication.

LPA Moleski interviewed three staff members (S3, S6, S7). In an interview, S3 admitted to administering an insulin injection to a diabetic client (C6) on one occasion.

This facility is hereby cited per 22 CCR Section 82075(b)(2). An exit interview was conducted and a copy of this report was left with Loeun.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE: DATE: 12/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2024
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 12/09/2024 01:35 PM - It Cannot Be Edited


Created By: Vincent Moleski On 12/09/2024 at 01:21 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: AIM HIGHER INC.
FACILITY NUMBER: 347004282

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/09/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82075(b)(2)
"Program staff, except those authorized by law, shall not administer injections..."

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, a staff member administered an injection to a client, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 12/10/2024
Plan of Correction
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Licensee agrees to conduct a staff training regarding injections.
vincent.moleski@dss.ca.gov
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:Stephen Richardson
LICENSING EVALUATOR NAME:Vincent Moleski
LICENSING EVALUATOR SIGNATURE:
DATE: 12/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/09/2024


LIC809 (FAS) - (06/04)
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