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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701290
Report Date: 03/04/2024
Date Signed: 03/04/2024 01:58:08 PM

Document Has Been Signed on 03/04/2024 01:58 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
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: 29DATE:
03/04/2024
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Administrator Ashley GudinoTIME COMPLETED:
02:15 PM
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Licensing program Analyst (LPA) Jason Lund arrived unannounced to conduct an post-licensing visit. LPA Lund met with the Administrator Ashley Gudino and explained the reason for the visit. Census: 29

LPA Lund and Administrator Ashley toured/inspected the facility inside and outside. 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 common’s areas and on the outside of the building. The facility has locked medication room observed medications to be stored and secured. LPA observed client’s room to have bed, dresser and night stand to be in compliance. Fire extinguishers were done on October 5, 2023, and smoke detectors are in compliance with fire safety. First aid kit was checked and is complete. LPA Lund reviewed three staff & three clients files, were in compliance.

No deficiencies cited on this visit, exit interview and report left.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE: DATE: 03/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/04/2024
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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