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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701065
Report Date: 01/25/2024
Date Signed: 01/25/2024 05:00:01 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 01/25/2024 05:00 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:
502701065
ADMINISTRATOR:WOODFORD, MAXFACILITY TYPE:
775
ADDRESS:318 MCHENRY AVETELEPHONE:
(916) 835-2933
CITY:MODESTOSTATE: CAZIP CODE:
95354
CAPACITY: 80CENSUS: 30DATE:
01/25/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Tiffany Stevenson, DirectorTIME COMPLETED:
05:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Renee Campbell made an unannounced visit to this facility to conduct an annual inspection on 01/25/2024 at 1300.  LPA Campbell met with Tiffany Stevenson, Director and stated the purpose of today’s visit. LPA inspected the physical plant to ensure compliance with Title 22 regulations.

This Day Program is licensed for eighty residents of which 10 may be non-ambulatory residents. In addition, this day program is open from Monday-Friday, 0900 to 1500. LPA Campbell and Director Stevenson toured the facility which included a common area, 4 bathrooms, kitchen and several small classrooms. Participants were observed interacting with peers and staff. During this visit, there were 26 participants present before they departed between 1400 and 1500. Of the 30 participants, LPA Campbell reviewed the files for 4. Of the 8 staff files, 2 files were reviewed.

The water temperature measured at 109 degrees Fahrenheit. The fire extinguishers were last inspected on 11/06/2023. The facility has a first aid kit containing tweezers and scissors but the facility does not administer medication. No emergency food supplies were observed for the day program as part of their emergency plan.

Per California Code of Regulations (CCR), Title 22, deficiencies are being cited on LIC 809-D. Appeal Rights provided. Failure to correct deficiencies may result in civil penalties. An exit interview held, and a report was provided to facility staff. LPA also discussed information with Director Tiffany Stevenson.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 01/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/25/2024
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 01/25/2024 05:00 PM - It Cannot Be Edited


Created By: Renee Campbell On 01/25/2024 at 03:46 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: 502701065

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/25/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/25/2024
Section Cited
HSC
1565

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1565 A facility shall have an emergency and disaster plan that shall include, (2) Plans for the facility to be self-reliant for a period of not less than 72 hours immediately following any emergency or disaster,... This requirement is not met as evidenced by :
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Licensee will included a shelter in place procedure in their Plan of Operation & fill out the most recent 610 D form for their program The form will then be faxed to the Department, Attn: Renee Campbell at 916-263-4744
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Based on observation, interviews and record reviews, the licensee did not ensure the day program had supplies for the participants in case of any emergency 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.
SUPERVISOR'S NAME:Lisa Rios
LICENSING EVALUATOR NAME:Renee Campbell
LICENSING EVALUATOR SIGNATURE:
DATE: 01/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/25/2024


LIC809 (FAS) - (06/04)
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