<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000295
Report Date: 11/10/2021
Date Signed: 11/10/2021 01:41:15 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 CENTERFACILITY NUMBER:
306000295
ADMINISTRATOR:ELENA WEINERFACILITY TYPE:
740
ADDRESS:3615 WEST BALL RD.TELEPHONE:
(714) 236-1170
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY:76CENSUS: 43DATE:
11/10/2021
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
01:16 PM
MET WITH:Elena WeinerTIME COMPLETED:
01:56 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Kimberly Lyman made an unannounced health and safety visit in conjunction with complaint visit 22-AS-20211109114256. LPA was greeted and granted entry by Administrator Elena Weiner and explained the reason for the visit.

During the course of the visit, LPA toured the facility. LPA observed residents participating in activities as well as relaxing in their rooms. Facility appears clean and sanitary and is odorless. Residents appeared well taken care of. LPA observed staff assisting residents in the facility. LPA observed covid precautions and temps are taken upon entry. No health or safety violations noted during visit.




Exit interview conducted and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly LymanTELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1