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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701556
Report Date: 02/20/2025
Date Signed: 02/20/2025 10:29:51 PM

Document Has Been Signed on 02/20/2025 10:29 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:CARLTON HOMEFACILITY NUMBER:
502701556
ADMINISTRATOR/
DIRECTOR:		KALU, ESTHERFACILITY TYPE:
735
ADDRESS:1629 CARLTON AVENUETELEPHONE:
(925) 998-1037
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY: 4CENSUS: 0DATE:
02/20/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Applicants, Patrick Kalu & Esther Kalu. TIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Announced pre-licensing visit was made with applicants, Patrick Kalu & Esther Kalu. LPA Jason Lund explained the reason for the visit.
The facility will be licensed to serve up to (4) clients at any given time. This Applicant was also seeking a program through Regional Center retain up to (4) clients at any given time. There were no residents in care during today's visit.
Tour/Inspection of the facility was conducted. LPA toured/Inspected the dining area, living area, and all other areas intended for client use. LPA observed to be furnished and maintained in compliance at this time.
The Facility had a Medication closet (locked) where medication will be stored. First aid kit was observed in the Medication closet to be present and contained all required components at this time.
A tour of the (4) private resident bedrooms, was conducted. Furnishings intended for use by the residents were observed to meet the needs of the residents at this time. The Facility also had an office for staff & one staff room.
There are one linen closets, in the hallways, it was observed to contain a sufficient supply of towels and linens able to meet the needs of the clients at this time.
A tour of the exterior grounds was conducted. A review of the facility perimeter fence, side gates, and walkways were observed to be maintained in compliance at this time. The facility has two fire extinguisher that expire on 2/13/2025 and had a working telephone.
This facility has been found to be in compliance at this time.
Both applicants, Patrick Kalu & Esther Kalu completed the Component 111 requirements.
An exit interview and report left.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE: DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/20/2025
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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