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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701065
Report Date: 02/23/2023
Date Signed: 02/28/2023 01:14:57 PM

Document Has Been Signed on 02/28/2023 01:14 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 AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:AIM HIGHER, INC.FACILITY NUMBER:
502701065
ADMINISTRATOR:WOODFORD, MAXFACILITY TYPE:
775
ADDRESS:318 MCHENRY AVETELEPHONE:
(916) 835-2933
CITY:MODESTOSTATE: CAZIP CODE:
95354
CAPACITY: 80CENSUS: 19DATE:
02/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Tiffany StevensonTIME COMPLETED:
04:00 PM
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Unannounced annual visit was conducted by Licensing Program Analysts, (LPAs) Kimberly Viarella and Charlie Yang on 02/23/2023. LPAs were met by the designated facility administrator, Tiffany Stevenson. She was interviewed briefly.
Census at this time was 19 participants.
The facility was toured and the following observations were made by the LPAs.
All rooms were equipped with adequate furniture to accommodate the needs of the program participants.
Fire Extinguishers (5) were all inspected on 11/09/2022 by Armor Fire Company.
The water temperature in the restroom, adjacent to the main activity room, was tested and found to be in compliance as it was within the range of 105 to 120 degrees. There were no toxic chemicals present in any of the restrooms.
LPAs also toured the following: an exercise room, library/quiet room, conference room, computer lab, additional restrooms/activity rooms, storage room, electrical closet and staff kitchen. LPAs observed that the staff kitchen had locked cabinets for cleaning supplies.
LPAs inspected the locked storage cabinet in the main activity room and observed that it contained art supplies including scissors.
LPAs inspected the exterior grounds of the building and found it to be in to be in compliance at this time. There were no bodies of water present.
There were no deficiencies observed or cited during today's visit.
The following forms and documents were requested to be updated and submitted into CCL for review by this LPA:
LIC 308
LIC 400
LIC 500
LIC 610
Copy of the updated liability insurance. Exit interview
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 02/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2023
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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