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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 585920003
Report Date: 05/01/2024
Date Signed: 05/01/2024 03:30:11 PM

Document Has Been Signed on 05/01/2024 03:30 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 CAREHOME 2FACILITY NUMBER:
585920003
ADMINISTRATOR/
DIRECTOR:		AGUIRRE, LEAHFACILITY TYPE:
735
ADDRESS:2044 FORBES COURTTELEPHONE:
(858) 717-6817
CITY:PLUMAS LAKESTATE: CAZIP CODE:
95961
CAPACITY: 4CENSUS: 0DATE:
05/01/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Leah Aguirre, licenseeTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On 5/1/2024 LPA Tryon visited the facility to conduct an annual review. LPA met with licensee Leah Aguirre.
The home currently does not have any clients living at the home, and has not had any since being licensed. The owners do wish to keep the license current, therefore LPA did a quick inspection of the home; 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 ready for residents to move in. The owner's family lives at the house at present (and will be staff when residents move in). Therefore, there are food supplies in the house that are adequate to meet regs. 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.

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

LPA completed the CARE Tool with licensee.

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

Exit interview conducted.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Todd Tryon
LICENSING EVALUATOR SIGNATURE: DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/01/2024
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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