306000295-3-26-2026-22-AS-RMRT-DSJQX4-20260326123255

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306000295
Report Date: 03/26/2026
Date Signed: 03/26/2026 12:33:03 PM

Document Has Been Signed on 03/26/2026 12:33 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/ DIRECTOR:	ELENA WEINER		FACILITY TYPE:	740
ADDRESS:	3615 WEST BALL RD.		TELEPHONE:	(714) 236-1170
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92804
CAPACITY: 76		CENSUS: 47	DATE:	03/26/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:00 AM
MET WITH:	Elena Weiner, Administrator (AD)		TIME VISIT/ INSPECTION COMPLETED:	12:45 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) Rose Ruppert made an unannounced visit to conduct an Annual Required Evaluation. LPA was greeted and granted entry and met with Administrator (AD) Elena Weiner at 8am. The facility is a single story building with a fire clearance of seventy six non-ambulatory and seventy six bedridden. A hospice waiver is approved for fifteen residents. Currently there are forty-seven residents in care and eight residents receive hospice services. The facility was a comfortable 74 degrees. LPA toured the facility with AD and tested the hot water temperature in four of four resident bathrooms. The hot water temperatures ranged between 112.4 and 115.9 degrees Fahrenheit. The fire alarms, carbon monoxide detectors and sprinkler system were inspected by an outside vendor on October 22, 2025 and passed inspection. The fire extinguishers were charged and inspected on May 6, 2025. The fire extinguishers will be inspected in two weeks for 2026 and the next fire alarm inspection for the facility will be scheduled in July 2026. The last fire drill was conducted on January 13, 2026. During the visit LPA observed residents listening to music in the television area and participating in activities such as ball toss and Bingo. Hazardous chemicals were stored and locked in three different locations: the kitchen, a locked storage room and in the laundry area; which is a separate area outside of the building which residents do not have access to. Washer and dryers were operational. All secured chemical areas had binders with Material Safety Data Sheets (MSDS) and pictures of the chemicals. Upon touring the kitchen, the facility had more than two-days of perishable items and seven-days of non-perishable food on hand. (Continued on LIC 809-C)

NAME OF LICENSING PROGRAM MANAGER: Alisa Ortiz
NAME OF LICENSING PROGRAM ANALYST: RoseMarie Ruppert
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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: 03/26/2026

NARRATIVE

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(Continued from LIC 809)

A grocery delivery was to be delivered in the afternoon. The oil extinguisher, in the kitchen, was charged and inspected on May 6, 2025. Sharps and knives are secured in the kitchen and special diet instructions for residents were observed and separated on different carts with a color coding system.

The dining room area was clean and LPA was told all dining room chairs are being updated and replaced. LPA toured the shaded central courtyard and the facility is also getting brand new patio furniture. There are no hazards or obstructions in the patio area; only sandbags which were used during the rainy season.

LPA reviewed three of three staff training and fingerprint records and reviewed five of five resident records. Staff in-services coincide on pay days and cover a variety of topics. LPA interviewed alert residents regarding their quality of care and spoke to staff present regarding care provided. LPA audited five of five Medication Administration Records and medications were being given as prescribed.

Based on the observations made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiencies cited on this date. An exit interview was conducted with Elena Weiner, Administrator and a copy of the report and files reviewed (LIC 858 & LIC 859) were given at the time of the visit.

NAME OF LICENSING PROGRAM MANAGER: Alisa Ortiz
NAME OF LICENSING PROGRAM ANALYST: RoseMarie Ruppert
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2026

LIC809 (FAS) - (06/04)

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