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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502701065
Report Date: 07/24/2024
Date Signed: 07/24/2024 04:46:48 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
07/18/2024 and conducted by Evaluator Renee Campbell
COMPLAINT CONTROL NUMBER: 27-AS-20240718112500
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: 35DATE:
07/24/2024
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Tiffany Stevenson, DirectorTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff did not safeguard the confidentiality of client’s records.
INVESTIGATION FINDINGS:
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On 07/24/24, Licensing Program Analyst (LPA) Renee Campbell arrived to the facility to open a complaint. LPA Campbell met with the Director, Tiffany Stevenson(S5) and stated the purpose of the visit.

LPA Campbell observed clients coming and going into the facility. A group of clients and staff were preparing for an outing at IHOP as stated by S5. The rest of the clients were engaged in socializing and group activities in the large common area. Once LPA Campbell was seated in an empty conference room, staff and client rosters were requested. Client and Staff schedules for the week of the incident were also provided. LPA Campbell then identified staff and residents for one on one interviews.

There were 3 (C2, C3 and C4) clients interviewed who had been present in the class when the incident occurred in June per the their client calendar. Of the 3, none of them remembered hearing any details
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
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 3
Control Number 27-AS-20240718112500
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: 502701065
VISIT DATE: 07/24/2024
NARRATIVE
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from an instructor regarding a car accident during the Life Skills Class. Of three staff interviewed, (S2, S3, S4), none reported witnessing S1 discussing a car accident as part of the Life Skills Class. When S1 was interviewed, they reported that they had said, “A car accident could make you anxious. Right?” and looked at C1.

Based on interviews, record reviews and S1’s admission, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED.

Per California Code of Regulations (CCRs) - Title 22, Div.6, Ch. 6, deficiencies are being cited on the attached 9099D during this visit.

If any deficiencies are not corrected by the noted due dates; civil penalties may be assessed. A copy of their rights was provided (LIC9058) and their signature on this form acknowledges receipt of these rights. A copy of this report was left with the day program. Exit Interview.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20240718112500
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: 502701065
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/02/2024
Section Cited
CCR
82072(a)(2)
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82072 Personal Rights (a) Each client shall have personal rights which include, but are not limited to, the following: (2) to be accorded safe, healthful and comfortable accommodations,
This requirement is not met as evidenced by:
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S5 will complete an in-service training about personal rights with all staff and provide a sign in sheet to verify completion by POC due date.
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Based on interviews and record reviews, the facility did not ensure safe … and comfortable accommodations which poses a potential Health, Safety or Personal Rights risk to persons 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: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3