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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345002936
Report Date: 10/15/2024
Date Signed: 10/15/2024 11:23:33 AM

Document Has Been Signed on 10/15/2024 11:23 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/
DIRECTOR:		GUEVARRA, CARAFACILITY TYPE:
735
ADDRESS:7105 9TH AVENUETELEPHONE:
(650) 745-6072
CITY:RIO LINDASTATE: CAZIP CODE:
95673
CAPACITY: 4CENSUS: 2DATE:
10/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:39 AM
MET WITH: Guevarra, Cara LicenseeTIME VISIT/
INSPECTION COMPLETED:
11:55 AM
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On October 15, 2024 at 9:45am, Licensing Program Analyst, (LPA) De Anna Williams-Lyons made an unannounced visit to conduct facilities required annual inspection. LPA met with Cara Guevarra, Administrator/ Licensee, whose Administrator certificate expires 8/3/2025. The temperature in the home was 76 degrees F.
LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, and kitchen. Bathrooms and bedrooms were clean and in good repair. There is a locked storage cabinet for medications and toxins; it was inaccessible. Food supply is adequate for 2-day perishable and 7-day nonperishable. Smoke alarms were checked and in good working order. LPA observed an adequate amount of linen and found the first aid kit to be complete. Hot water temperature measures at 105 degrees F. LPA observed a working washer and dryer with all supplies in accessible. LPA also observed the exterior of the grounds to be in good order. There are no bodies of water on the premises.
LPA reviewed 2 resident files and 5 staff files. Resident files were found to be complete and current. A review of staff records indicates that all facility staff have received criminal record clearances and are associated to this facility. Staff records reviewed also indicate current first aid & CPR certificates. Facility is conducted staff training as required.
LPA and Cara did not completed the Infectious Control Questionnaire due to computer issues. Because of this, LPA was unable to conduct interviews with staff or residents. The facility never had Covid-19. In the areas that were evaluated, no deficiencies were observed.
Per California Code of Regulations, Title 22, no citations were issued.
Licensee shall submit updated copies of the LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610E the Emergency Disaster Plan, and copy of your current Liability Insurance to update the facility file in our Regional Office. Administrator shall submit the listed documents to Licensingno later than November 15, 2024.
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: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/15/2024
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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