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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701425
Report Date: 10/30/2024
Date Signed: 10/30/2024 04:16:15 PM

Document Has Been Signed on 10/30/2024 04:16 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:
392701425
ADMINISTRATOR/
DIRECTOR:		WOODFORD, MAXFACILITY TYPE:
775
ADDRESS:2609 E. HAMMER LANETELEPHONE:
(916) 995-5164
CITY:STOCKTONSTATE: CAZIP CODE:
95210
CAPACITY: 70CENSUS: 63DATE:
10/30/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:45 PM
MET WITH:Tanya MongeTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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On 10-30-24 at 2:45pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct a case management visit regarding an incidents reported on 10-2-24 and 10-21-24. LPA met with Program Director Tanya Monge and explained the purpose of the visit. LPA reviewed physician's report, individualized program plan (IPP), and additional documentation pertaining to client1 (C1). LPA also conducted a brief interview with Program Director.

Day program reported that on 10/2/2024 at approximately 1:10pm C1 was sitting in the classroom when C2 walked in. C1 then stood up and grabbed C2 by the neck with both hands. Day program staff were able to successfully redirect C1 from the behavior and separated clients. C1 engaged in multiple episodes of grabbing staff's necks and arms between the dates of 7/3/2024 and 7/24/2024. Based on interview and record review, C1 was given a 30-day notice to discontinue day program services at Aim Higher, Inc due to increasing behaviors and outside of day program's scope to mitigate these behaviors. Day program participated in a meeting with C1's responsible party prior to issuance of 30-day notice. C1 was suspended 10-2-24. The 30-day notice was issued 10-4-2024 with an intended date of discontinuance on 11-4-24. C1 then returned 10-7-24.

On 10-21-24, C1 was sitting in the classroom and suddenly grabbed another participant with both hands and squeezed the other participants (C3) left arm. Facility staff intervened immediately and separated both clients. Based on interview, facility staff implemented interventions for C1 after the 10-2-24 incident including utilizing communication devices, noise cancelling headphones and additional supervision. Interview also revealed C1 is no longer attending day program as of 10-21-24. Incident reports were submitted to licensing agency within regulatory time frames.

No citations issued as a result of this case management. An exit interview was conducted with Program Director and a copy of this report was provided to Program Director.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE: DATE: 10/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/30/2024
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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