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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004682
Report Date: 06/17/2022
Date Signed: 06/17/2022 12:46:31 PM

Document Has Been Signed on 06/17/2022 12:46 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:CARRA HOMES, INC.FACILITY NUMBER:
306004682
ADMINISTRATOR:CAROLYN JIMENEZFACILITY TYPE:
735
ADDRESS:8074 CACTUS CIRCLETELEPHONE:
(714) 742-3548
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 6CENSUS: 5DATE:
06/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:06 AM
MET WITH:Carolyn Jimenez, Jerome Cabuso, Romy Matanguihan, Maripaz MilayaTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Edward Tapia made an unannounced required annual inspection at this facility. LPA met with Administrator Carolyn Jimenez and stated the purpose of this visit.

The facility is a single-level structure and licensed for six non-ambulatory clients. This facility offers care for the Developmentally Disabled.

At about 11:06 am, LPA Tapia was granted entry after completing the Coronavirus 2019 (COVID 19) screening procedure. For this visit, LPA observed five clients in care and three staff members on duty. LPA toured the interior and exterior portions of the facility. There were three client rooms all of which were shared rooms. Client rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. LPA Tapia did observe two rooms that were for staff only. Manual smoke detectors and carbon monoxide alarms were tested to be operational. Bathroom (1) was observed to be in good repair and provided with grab bars and hot water was measured at 109.7 degrees Fahrenheit. Facility met the minimum two day supply of perishable and seven day supply of non-perishable food stock requirements, cleaning supplies and sharp items were inaccessible to clients in care. Facility had adequate supplies of personal protective equipment in place. Fire extinguisher was observed to be charged and operational. The space between the kitchen and staff restroom contained an operational washer/dryer. For the exterior portion, facility had outside furniture in good repair; and grounds were free of tripping hazards. LPA observed gardening tools outside and staff immediately removed and locked up equipment.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Edward Tapia
LICENSING EVALUATOR SIGNATURE: DATE: 06/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: CARRA HOMES, INC.
FACILITY NUMBER: 306004682
VISIT DATE: 06/17/2022
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Facility also had a two-car garage which is used for storage. Kitchen was in good repair with knifes and cleaning supplies kept locked. LPA Tapia reviewed the COVID 19 mitigation plan of the facility. LPA discussed Assembly Bill 665 that requires a licensee of any adult care residential facility that has internet service to provide at least one internet access device, such as a computer, smart phone, tablet or other device, that: can support real-time interactive applications; is equipped with video conferencing technology, including microphone and camera functions; and is dedicated for client or resident use.

For this visit, no deficiency was noted in areas observed. No citation was issued. One advisory was issued today.

LPA Tapia conducted an exit interview with Administrator Carolyn Jimenez and copy of this report was explained and left at the facility.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Edward Tapia
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2022
LIC809 (FAS) - (06/04)
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