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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315920112
Report Date: 10/23/2024
Date Signed: 10/23/2024 10:43:50 AM

Document Has Been Signed on 10/23/2024 10:43 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:CARTER HOUSE SENIOR LIVINGFACILITY NUMBER:
315920112
ADMINISTRATOR/
DIRECTOR:		CARTER, TERESAFACILITY TYPE:
740
ADDRESS:251 GREY COURTTELEPHONE:
(773) 203-6964
CITY:LINCOLNSTATE: CAZIP CODE:
95648
CAPACITY: 6CENSUS: 5DATE:
10/23/2024
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Teresa CarterTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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Licensing Program Analysts (LPA) Graham Gunby and Cheyenne Ratajczak arrived unannounced to conduct a post-licensing inspection. LPAs met with administrator, Teresa Carter, who arrived at 9:30am.

LPAs and Administrator conducted a tour of the interior of the facility and inspected the physical plant, kitchen, bedrooms, bathrooms, laundry area, and backyard area. LPA observed the facility to be free of odor, clean and in good repair. There is sufficient furniture and lighting throughout the facility. LPA observed required 7 day non-perishable and 2 day perishable food. LPA observed locked medications, knives and toxins to be inaccessible to residents. LPA observed four (4) resident files and three (3) staff files to be organized and complete.

LPA observed all required documents to be posted in entry.

Exit interview conducted. No deficiencies cited at this time.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Graham Gunby
LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2024
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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