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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701425
Report Date: 12/11/2024
Date Signed: 12/11/2024 03:07:02 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/07/2024 and conducted by Evaluator Michael Bilger
COMPLAINT CONTROL NUMBER: 27-AS-20241107081417
FACILITY NAME:AIM HIGHER, INC.FACILITY NUMBER:
392701425
ADMINISTRATOR:WOODFORD, MAXFACILITY TYPE:
775
ADDRESS:2609 E. HAMMER LANETELEPHONE:
(916) 995-5164
CITY:STOCKTONSTATE: CAZIP CODE:
95210
CAPACITY:70CENSUS: 70DATE:
12/11/2024
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Tanya Monge (via phone)TIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Client not assisted with medication
Medication lost
Facility did not meet its reporting requirements
INVESTIGATION FINDINGS:
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On 12/11/2024 at 1:00pm, Licensing Program Analyst (LPA) Michael Bilger arrived at facility unannounced to deliver and discuss findings for the allegations noted above. LPA met with staff1(S1) and explained the purpose of the visit. Program Director (PD) Tanya Monge was contacted by LPA who read report via phone. During this investigation, LPA conducted interviews with three staff members and one additional witness. LPA also reviewed facility file documentation including medication log sheets, central medication storage lists, physician's report, individualized program plan (IPP), facility program design, medication administration policy and procedures, and staff training records. Additionally, LPA conducted a facility observation on 11/14/2024.
Allegation: Client not assisted with medication. LPA conducted interviews and record reviews as noted above. Based on interviews and record reviews it was determined that client1 (C1) has a physician’s order which states “Albuterol inhaler every 4-6 hours for shortness of breath (SOB) wheezing as needed.”

{Cont. on 9099C}
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 27-AS-20241107081417
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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
VISIT DATE: 12/11/2024
NARRATIVE
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It was further revealed through interviews that although the physician’s order was in place, C1 did not receive medication and displayed signs and symptoms requiring use of the medication on at least three different occasions. Interviews also revealed that C1’s responsible party inquired about availability and use of the inhaler during the early part of November 2024, and learned from staff that medication was not available. Additionally, it was revealed through interviews and record reviews that C2 has a physician’s order for use of EpiPen with medication, however, such device was not available in medication storage at facility for use as necessary. Interviews and record reviews conducted revealed that medication orders existed, and clients noted above were previously assisted with medication, however, were not assisted recently due to medication misplaced. As a result, the preponderance of evidence standard is met, and this allegation is SUBSTANTIATED.

Allegation: Medication lost. LPA conducted interview and record reviews as noted above. Based on interviews and record reviews it was determined that client1 (C1) has a physician’s order which states “Albuterol inhaler every 4-6 hours for shortness of breath (SOB) wheezing as needed.” Additionally, it was determined that C2 has an order in place for use of an EpiPen with medication as needed. Interviews conducted revealed medications noted above had previously been in storage and dispensed to clients with assistance while at facility’s previous location prior to facility’s move to their current location on 7/31/2024. Interviews further revealed that when C1’s responsible party inquired about the use of C1’s inhaler, it was expressed that inhaler could not be found, and revealed staff was not aware of an order for the inhaler. Sufficient evidence could not be found to indicate medication accountability for C1 and C2 after facility’s location move, and interviews conducted indicated medication was lost during this transition. As a result, the preponderance of evidence standard is met, and this allegation is SUBSTANTIATED.
Allegation: Facility did not meet its reporting requirements. LPA conducted interviews and record reviews as noted above. Based on interviews and record reviews, it was determined that physician orders for medication existed for C1 and C2, however, not dispensed due to medication misplaced. Interviews further revealed that facility staff, upon learning of the misplaced medication and clients not received medication due to the misplacement, did not report incident to licensing department per regulatory requirements. The preponderance of evidence standard is met, and this allegation is SUBSTANTIATED.
As a result of this investigation, citations are issued under Title 22, Division 6 and noted on LIC 9099D. An exit interview was conducted with Program Director and a copy of this report was provided. LIC 811 and Appeal Rights provided. PD gave permission for S1 to sign this report in her physical absence.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 27-AS-20241107081417
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/12/2024
Section Cited
CCR
80075(b)
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80075(b) Health Related Services. (b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications. This requirement was not met as evidenced by:
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Licensee will submit a plan ensuring how clients will be assisted with medication as ordered. Plan to be submitted to LPA by POC due date.
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Based on interviews and record reviews, facility staff did not assist C1 and C2 with medication as ordered due to unavailability of medication. This posed an immediate health and safety risk to residents in care.
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Type A
12/12/2024
Section Cited
CCR
80075(a)
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80075(a) Health Related Services. (a)The licensee shall ensure that each client receives necessary…medical or dental services. This requirement was not met as evidenced by:
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Licensee will submit a plan ensuring the accountability of medication and services given to clients as needed in a timely and sufficient manner. Plan to be submitted to LPA by POC due date.
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Based on interviews and record reviews, C1 and C2’s medication as ordered was discovered to be misplaced and unaccounted for since facility’s location move on or about 7/31/24 resulting in C1 and C2 not receiving medication related services as needed. This posed an immediate health and safety risk to residents in care.
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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.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 27-AS-20241107081417
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/23/2024
Section Cited
CCR
82061(a)(1)(D)
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82061(a)(1)(D) Reporting Requirements. (a) Upon the occurrence…of any of the events specified in Section 82061(a)(1), a report shall be made to the licensing agency within the agency's next working day during its normal business hours. …a written report…shall be submitted to the licensing agency within seven days following the occurrence of such event. (1) Events reported shall include the following: (D) Any unusual incident which threatens the physical or emotional health or safety of any client. This requirement was not met as evidenced by:
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Licensee will submit a plan ensuring the timeliness of necessary reporting to licensing department. Plan to be submitted to LPA by POC due date.
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Based on interview and record review, Licensee did not ensure the reporting of lost medication for client. This posed a potential health and safety risk for clients in care.
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Licensee will read regulation 82061 and submit a signed declaration of understanding to LPA by POC due date.
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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.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4