306000295-7-30-2024-22-AS-MTEA-D7NVKG-20240730163020

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306000295
Report Date: 07/30/2024
Date Signed: 07/30/2024 04:30:44 PM

Document Has Been Signed on 07/30/2024 04:30 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

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: 56	DATE:	07/30/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Elena Weiner		TIME COMPLETED:	04:45 PM

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Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. At around 8:00 AM, LPA Tea was greeted and granted entry into the facility by caregiver Rosa Ramirez and explained the reason for the visit. The Administrator (AD) Elena Weiner and Assistant Administrators (AA) Matthew Weiner and Sylvia Garcia arrived shortly after to assist during the visit.

The facility is a residential care facility for elders, focused on memory care. The facility is licensed for 76 non-ambulatory residents, in which 76 may be bedridden, and have a hospice waiver for 15. Currently there are 52 residents in care and 8 of the residents are on hospice.

At 8:15 AM, LPA Tea reviewed six resident files and six staff files. Resident files and staff files contained all required documentation. Upon review of records, the facility is up to date with required quarterly fire drill, which was last conducted on June 15, 2024. AD Weiner’s current certificate expires on July 20, 2025, but due to the department’s back log in processing administrator certificates she has yet to physically receive her administrator certificate.

LPA Tea along with AD Weiner and AA Matthew Weiner toured the physical plant at 10:58 AM. LPA toured the physical plant, checked food service, and the first aid kit. The facility is a single-story unit building that consists of 38 resident rooms with shared bathrooms. There are common areas, dining rooms, resident shower rooms, and kitchen for meal preparation. In the middle of the facility is the courtyard where there is a shaded patio seating area for residents to enjoy. The kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Emergency food supplies were in the pantry of the kitchen and emergency water supply was stored in a secured closet in the front part of the facility.

Annual continuation on LIC809C

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 287-4084
LICENSING EVALUATOR NAME: Michael Tea	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: KARLTON RESIDENTIAL CARE CENTER	FACILITY NUMBER: 306000295
	VISIT DATE: 07/30/2024

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LPA observed smoke detectors/carbon monoxide in common areas and bedrooms are operational. The fire and smoke detectors are serviced and maintained through a third-party company. They were last serviced on May 28, 2024. Fire extinguishers are fully charged throughout the facility. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each client comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly. Grab bars were secure, and showers were free of mold/mildew in resident shower rooms. Water temperature measured between 117.1 F degrees and 128 F degrees being the highest. AA Weiner adjusted the water temperature of the water tanks to meet regulation standards while on site. It would take half day for the tank to adjust to the temperature changes due to the size of the water tanks. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions.

LPA Tea observed residents in the morning and throughout the day doing exercises in the common area. Residents were also singing songs and playing bingo later in the afternoon. Activities are posted in the front and back of the facility with different activities for residents to participate.

At 11:45 AM LPA reviewed medication storage and administration. Medications are stored in a med room that is locked and secured. Medications are being administered per physician order. LPA interviewed residents regarding their quality of care and spoke to staff present regarding care provided.

Based on the observation made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations.

This report was reviewed with Assistant Administrators Matthew Weiner and Sylvia Garcia a copy of this report LIC809, 809-C, LIC858, LIC859, and LIC9102TV was read and provided to the facility.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 287-4084
LICENSING EVALUATOR NAME: Michael Tea	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024

LIC809 (FAS) - (06/04)

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