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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004682
Report Date: 06/06/2024
Date Signed: 06/06/2024 02:27:03 PM

Document Has Been Signed on 06/06/2024 02:27 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/
DIRECTOR:
CAROLYN JIMENEZFACILITY TYPE:
735
ADDRESS:8074 CACTUS CIRCLETELEPHONE:
(714) 742-3548
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 6CENSUS: 0DATE:
06/06/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:05 AM
MET WITH:Carolyn JimenezTIME VISIT/
INSPECTION COMPLETED:
02:35 PM
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Licensing Program Analysts (LPA) Jerome Haley conducted an unannounced visit for the purpose of conducting a required one-year annual inspection. LPA Haley was greeted and granted entry by staff and explained the reason for the visit. Staff contacted Administrator Carolyn Jimenez who arrived a short time later and was present for the remainder of the of the visit.

During the inspection, LPA Haley observed all client bedrooms and bathrooms. All client bedrooms had the necessary elements and were in compliance with regulation guidelines.

The client bathroom were clean and organized. Hot water temperatures were measured at 110.5 degrees Fahrenheit. No hazardous items were observed in the client bathroom, and all grab bars were tightly secured to the wall.

In the kitchen a perishable food supply that meets regulation requirements was observed in the refrigerator. A non-perishable food supply that meets regulation requirements was observed in the cabinets. All four burners on the stove were operational. Client medications, P&I funds, and a first aid kit are kept in a locked cabinet. There’s a small refrigerator used to store refrigerated medication for a client. The medication was secured in a locked bag inside the refrigerator.

There’s a small laundry area in between the kitchen and staff bathroom with a washer and dryer. Knives, sharp objects, and hazardous cleaning materials are kept locked in a cabinet in the laundry area.

The garage is used to store various facility items. There's a large supply of adult diapers, a generator, fire extinguishers, wheelchairs, walkers, and extra clothing. Administrator Jimenez was advised on keeping the garage free of clutter.

An emergency supply of food, water, and emergency bags for all he clients prepared and ready to go was observed in a closet in the living room. Client and staff files are kept in a locked office near the front door.

Continued on LIC809C

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE: DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/06/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: 06/06/2024
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The backyard was clean, organized, and walkways were free of obstruction. A shaded patio area with a table and chairs was observed. There is a locked shed in the backyard used to store miscellaneous gardening items. The side exit gate is self-closing and self-latching.

Smoke detectors, and carbon monoxide detectors tested operational. A fully charged fire extinguisher was observed mounted on the wall in the kitchen near the locked medication cabinet.

During the visit an audit of all client medications and P&I funds was completed.

An emergency evacuation drill was conducted March 6, 2024 and will continue to be conducted quarterly for staff on each shift.

No deficiencies are being cited as a result of today’s visit. A Technical Violation will be issued for clutter observed in the garage, and in the backyard.

An exit interview conducted, and a copy of this report was provided to Administrator Jimenez.

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2024
LIC809 (FAS) - (06/04)
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