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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701290
Report Date: 07/10/2023
Date Signed: 07/10/2023 01:38:14 PM

Document Has Been Signed on 07/10/2023 01:38 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:CARVER CARE RESIDENTIALFACILITY NUMBER:
502701290
ADMINISTRATOR:CALLA, PATRICIAFACILITY TYPE:
735
ADDRESS:1009 CARVER ROADTELEPHONE:
(209) 204-5157
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY: 70CENSUS: DATE:
07/10/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Administrator Patricia CallaTIME COMPLETED:
02:15 PM
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Licensing program Analyst (LPA) Jason Lund conducted an announced pre-licensing visit at the above Facility. LPA met with the Administrator Patricia Calla and License Dennis Monterosso. LPA Lund, Patricia Calla and License Dennis Monterosso toured the facility inside and outside. There are no clients at the facility at this time.

The facility has 2 common areas, five staff offices, cleaning storage, resident phone area, linen storage, conference room, medical office, dining area, kitchen, break room, three staff bathrooms, nine clients’ showers, and eleven bathrooms. There are cameras in the inside commons areas and on the outside of the building. The facility has locked medication room.

Fire extinguishers and smoke detectors are current and in compliance with fire safety. First aid kit was checked and is complete.

Component III was waived. Based on the today's Pre-licensing inspection, there are no outstanding issues with the physical plant. Final approval of the license will be by the Applications Analyst is pending. Exit interview held with the Administrator Patricia Calla and License Dennis Monterosso and a copy of report given.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE: DATE: 07/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/10/2023
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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