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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 585920003
Report Date: 06/06/2023
Date Signed: 06/06/2023 11:08:54 AM

Document Has Been Signed on 06/06/2023 11:08 AM - 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, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME:AGUIRRE CARE HOME 2FACILITY NUMBER:
585920003
ADMINISTRATOR:AGUIRRE, LEAHFACILITY TYPE:
735
ADDRESS:2044 FORBES COURTTELEPHONE:
(858) 717-6817
CITY:PLUMAS LAKESTATE: CAZIP CODE:
95961
CAPACITY: 4CENSUS: 0DATE:
06/06/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Leah AguirreTIME COMPLETED:
11:00 AM
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06/06/2023 10:00 aM Licensing Program Analyst (LPA) Sarah Benson and Lauren Crocker Licensing Program Manager arrived at the facility an announced pre Licensing inspection. LPA met with Leah Aguirre Administrator and explained the purpose of the visit.


LPA Benson and the administrator toured the facility together to ensure the facility is ready for licensure. Areas toured include but are not limited to four (4) resident rooms, one Staff room, common areas, three (3 1/2) bathrooms, kitchen, storage areas and back yard.

Common area was clean and in good repair. All bedrooms had required furniture, bedding, and lighting. Medication is locked in a locked closet. First aid kit fully stocked and ready for emergency use. Fire extinguisher fully charged. Smoke detectors are all operational exp 08-04-23. Hot water temperature measured within required Title 22 regulations of 105 degrees F and 120 degrees F. All required postings are displayed within facility. No pools/bodies of water are on premises. No firearms are on premises. Disaster plan is in place.

Exit interview conducted, a copy of the report given to Leah Aguirre Administrator.

THIS FACILITY IS READY TO BE LICENSED.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sarah Benson
LICENSING EVALUATOR SIGNATURE: DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/06/2023
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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