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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
502701290
Report Date:
04/25/2024
Date Signed:
04/25/2024 03:00:10 PM
Document Has Been Signed on
04/25/2024 03:00 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 RESIDENTIAL
FACILITY NUMBER:
502701290
ADMINISTRATOR/
DIRECTOR:
CALLA, PATRICIA
FACILITY TYPE:
735
ADDRESS:
1009 CARVER ROAD
TELEPHONE:
(209) 204-5157
CITY:
MODESTO
STATE:
CA
ZIP CODE:
95350
CAPACITY:
70
CENSUS:
40
DATE:
04/25/2024
TYPE OF VISIT:
POC
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:
Administrator Ashley Gudino
TIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to conduct a proof of correction (POC) visit. LPA Lund met with Administrator Ashley Gudino and explained the reason for the visit.
LPA Lund received proper POC documentation for the deficiency cited on 4/8/2024.
No deficiencies were observed and cited during this visit.
Exit interview conducted and report left.
SUPERVISORS NAME
:
Lisa Rios
LICENSING EVALUATOR NAME
:
Jason Lund
LICENSING EVALUATOR SIGNATURE
:
DATE:
04/25/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
04/25/2024
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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