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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315920112
Report Date: 02/18/2025
Date Signed: 02/18/2025 12:44:25 PM

Document Has Been Signed on 02/18/2025 12:44 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 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:
02/18/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Caregiver Chelsea HayeTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Graham Gunby arrived on Tuesday February 18, 2025 to conduct the unannounced annual inspection. LPAs met with caregiver, Chelsea Haye, and explained the purpose of the visit.

During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA Gunby reviewed client (5) and staff (3) files. All client files contained the required paperwork. All staff files contained the required paperwork and training.

LPA and Caregiver toured the facility together to ensure the health and safety of clients in care. The areas toured included bedrooms, common areas, kitchen, bathrooms, laundry room, back yard and garage. All chemicals and toxins were kept locked and inaccessible to clients. Facility has one fire extinguishers (living room). In the areas toured, there were no health or safety violations observed.

LPAs and Caregiver completed the care tool together and found the facility to be in compliance.

No deficiencies cited. Exit interview conducted. A copy of this report was emailed to the Administrator.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Graham Gunby
LICENSING EVALUATOR SIGNATURE: DATE: 02/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/18/2025
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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