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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002936
Report Date: 10/27/2023
Date Signed: 10/27/2023 09:34:45 AM

Document Has Been Signed on 10/27/2023 09:34 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, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:CARA'S CARE HOMEFACILITY NUMBER:
345002936
ADMINISTRATOR:GUEVARRA, CARAFACILITY TYPE:
735
ADDRESS:7105 9TH AVENUETELEPHONE:
(650) 745-6072
CITY:RIO LINDASTATE: CAZIP CODE:
95673
CAPACITY: 4CENSUS: 0DATE:
10/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Cara Guevarra Licensee, TIME COMPLETED:
09:58 AM
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On October 27, 2023 at 9:00am, Licensing Program Analyst (LPA) De Anna Williams-Lyons arrived unannounced to conduced an Annual Inspection of the facility to ensure compliance with Title 22 regulations. LPA Lyons met with Cara Guevarra, Administrator, who assisted LPA in today’s inspection. The Administrator certificate expires 8/3/2023. The new certificate is Pending.

The current census is 0. The facilities Administrator’s Certificate, Emergency Disaster Plan, Resident’s Rights and Facility Sketch was available for viewing. The room temperature was 73 degrees F which is within range.

LPA inspected the interior and the exterior of the facility including the common living spaces, the kitchen, resident bedrooms and bathrooms. In the kitchen area, cabinets and drawers were reviewed. Knives and sharp objects were reviewed to make sure that they were locked and made inaccessible to the residents at all times. Hot water temperatures were taken and measured at 106 degrees F, which is within the allowed range of 105-120 degrees. There’s appropriate lighting throughout the facility. Everything is the same from 1 year ago.



First aid kit was present and included the required scissors, tweezers, thermometer and guide. Fire alarms, smoke alarms, and carbon monoxide detectors operate properly. Fire extinguisher is maintained and ready for emergency use and in compliance at this time.

Cara and LPA did not complete another Infectious Control questionnaire since there have been no residents to date..

No violations observed at this time. An exit interview was conducted and a copy of this report was given to Cara.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons
LICENSING EVALUATOR SIGNATURE: DATE: 10/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/27/2023
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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