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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701425
Report Date: 12/11/2024
Date Signed: 12/11/2024 03:10:06 PM

Document Has Been Signed on 12/11/2024 03:10 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: 70DATE:
12/11/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Tanya MongeTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
NARRATIVE
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On 12/11/2024 at 2:00pm, Licensing Program Analyst (LPA) Michael Bilger arrived at facility unannounced to conduct a case management regarding medication training requirements. LPA met with staff3 (S3) and explained the purpose of the visit. Program Director (PD) Tanya Monge was present via phone with LPA. LPA conducted record reviews of staff2 (S2) and S3 and conducted interview with Program Director as part of an investigation regarding complaint # 27-AS-20241107081417. Based on interviews and record reviews, it was revealed that S2 and S3 have assisted clients with medication, however, evidence of medication training does not exist as required per Section 82065(f)(4). A review of S2 and S3 staffing records did not reveal related experience in medication assistance. It was determined through investigation related to complaint #27-AS-20241107081417 that various clients in care did not receive medication as ordered and S2 and S3 assigned to assist clients with medication were unaware of physician orders in place for these medications.

As a result of today’s case management, citation is issued under Title 22, Division 6. An exit interview was conducted with Program Director via phone and a copy of this report was provided. PD gave permission for S3 to sign this report. Appeal rights provided.

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.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/11/2024 03:10 PM - It Cannot Be Edited


Created By: Michael Bilger On 12/11/2024 at 02:47 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: 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
82065(f)(4)

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Personnel Requirements. (f) All personnel shall be given on-the-job training or shall have related experience providing knowledge of and skill in the following areas, as appropriate to the job assigned and as evidenced by safe and effective job performance. (4) Assistance with prescribed medications which are self-administered. This requirement was not met as evidenced by:
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Licensee will review all staff training records and ensure training requirements related to Section 82065(f) are completed and placed in staffing records. Licensee to submit proof of completed training to LPA by POC due date. Audit to be completed and submitted to LPA by POC due date.


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Based on interviews and record reviews, Licensee did not ensure the completion of medication training for S2 and S3 and assigned this staff to assist clients with medication. This posed a potential health and safety risk to clients in care.
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Licensee to read regulation 82065(f) 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.
SUPERVISOR'S 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


LIC809 (FAS) - (06/04)
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