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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 585002753
Report Date: 06/21/2024
Date Signed: 06/21/2024 04:52:56 PM

Document Has Been Signed on 06/21/2024 04:52 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:AGUIRRE CARE HOMEFACILITY NUMBER:
585002753
ADMINISTRATOR/
DIRECTOR:		AGUIRRE, LEAHFACILITY TYPE:
735
ADDRESS:966 SUGARSTICK DRIVETELEPHONE:
(858) 717-6817
CITY:PLUMAS LAKESTATE: CAZIP CODE:
95961
CAPACITY: 4CENSUS: 4DATE:
06/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Leah Aguirre, Licensee; Ayson Aguirre, StaffTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On 6/21/2024 LPA Tryon visited the facility to conduct an annual review. LPA met with staff Ayson Aguirre and licensee Leah Aguirre.
The home currently as 4 residents. The LPA took a tour of the home with Mr. Aguirre and completed the CARE Tool.
The home is clean, nicely furnished and in good condition. LPA toured the home including common areas, kitchen, bedrooms, bathrooms, hallways, laundry, yard. Bedrooms have appropriate furniture and are clean and neat. Food supplies in the house meet the requirement of 2 days perishable and 7 days non-perishable. Plumbing, fixtures are in good condition. Smoke/carbon monoxide detectors installed, along with fire extinguisher.

There are no pools or fireplaces in the home. Home is spacious, with a good-size back yard and a shaded patio and gazebo area.

There is locked storage for medications, cleaners, sharp knives and other potentially hazardous items.

LPA completed the CARE Tool with licensee.

LPA interviewed 3 residents and 2 staff. Preferred business language of staff is English.

At this time, no deficiencies were cited. Home appears to be in substantial compliance with regulations.

Exit interview conducted.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Todd Tryon
LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2024
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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