306000295-5-13-2021-22-AS-LADS-C38M9Q-20210521092505

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306000295
Report Date: 05/13/2021
Date Signed: 05/13/2021 02:30:41 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/08/2021 and conducted by Evaluator Albert Marin

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20210408150721

FACILITY NAME:	KARLTON RESIDENTIAL CARE CENTER		FACILITY NUMBER:	306000295
ADMINISTRATOR:	ELENA WEINER		FACILITY TYPE:	740
ADDRESS:	3615 WEST BALL RD.		TELEPHONE:	(714) 236-1170
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92804
CAPACITY:	76	CENSUS: 39	DATE:	05/13/2021
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Administrator Elena Weiner		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Facility was understaffed.

INVESTIGATION FINDINGS:

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As precautionary measure during the Coronavirus 2019 (COVID-19) pandemic, Licensing Program Analyst (LPA) Albert Marin made an unannounced teleconference visit to deliver the investigation findings for the complaint filed against the facility. LPA met with Administrator Elena Weiner and stated the purpose of the visit.

On April 8, 2021, The Department received a complaint with allegation that the facility was understaffed. Based on observation via virtual tour conducted last April 12, 2021 and direct observation conducted last May 12, 2021, LPA Marin observed residents being attended with their needs. Residents appeared neat and dressed appropriately. In resident’s rooms, beds were made, clutter free and free of any offending odor. Common areas were kept clutter free and in good repair. On both occasions, LPA observed at least five staff members on the floor attending to 39 residents. Per interviews, eight out of eight witnesses stated that they had not observed any staffing issues or concerns, or the floor was understaffed at any time. Per file review, there were six to seven staff members scheduled for morning shifts; five to six staff for afternoon shifts ; and two staff for night shifts. Staff schedules were prepared with overlapping working hours between two shifts to address the needs of the residents. (Page 1/2)

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Albert Marin	TELEPHONE: (714) 309-7843
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20210408150721

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: KARLTON RESIDENTIAL CARE CENTER	FACILITY NUMBER: 306000295
	VISIT DATE: 05/13/2021

NARRATIVE

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This agency has investigated the complaint alleging that the facility was understaffed. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and is without a reasonable basis. We have therefore dismissed the complaint.

LPA conducted a phone exit interview with Administrator Elena Weiner. LPA will provide a copy of this report via email. AD agreed to acknowledge its receipt.

(Page 2/2)

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Albert Marin	TELEPHONE: (714) 309-7843
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2021

LIC9099 (FAS) - (06/04)

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