306000295-5-4-2022-22-AS-AORZ-CEKRTG-20220519131818

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306000295
Report Date: 05/04/2022
Date Signed: 05/04/2022 12:33:03 PM

Unsubstantiated

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
11/09/2021 and conducted by Evaluator Kimberly Lyman

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20211109114256

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: 45	DATE:	05/04/2022
		UNANNOUNCED	TIME BEGAN:	11:51 AM
MET WITH:	Elena Weiner		TIME COMPLETED:	12:05 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Physical abuse: Resident sustained unexplained injuries while in care

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analysts (LPAs) Kimberly Lyman and Joseph Alejandre conducted an unannounced complaint visit to deliver findings on the above allegation. LPAs were greeted and granted entry into the facility by Administrator Elena Weiner and explained the reason for the visit.
During the course of the investigation, the Department interviewed staff and witnesses as well as reviewed and obtained pertinent documentation such as physician report dated 07/19/2021 and medical records dated 10/23/2021-10/29/2021. Regarding the allegation that resident sustained unexplained injury while in care, the investigation revealed the following:
On 10/12/2021, Resident 1 (R1) was hospitalized at Chapman Global Medical Center for psychiatric treatment and self-injurious behavior. Upon return to the facility on 10/29/2021, R1 was observed to have visible bruises on legs, arms and right side of lip. R1 returned to Chapman Global Medical Center on 11/06/2021 for confusion and lack of sleep. Upon admission, it was observed that R1 had multiple bruises on lower extremity as well as a vaginal laceration with blood clots and drainage. R1’s family member and medical records reviewed indicated hospital CONTINUED ON LIC 9099 DATED 05/04/2022

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly Lyman	TELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022

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

LIC9099 (FAS) - (06/04)

Page: 1 of 2

Control Number 22-AS-20211109114256

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: 05/04/2022

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
26
27
28
29
30
31
32

personnel were not concerned with any sexual abuse following an examination and tests completed 11/06/2021. Upon R1’s return to the facility, the facility Administrator submitted a SOC 341, Abuse Report, on 11/09/2021. The report CA00761273 referenced an investigation completed by California Department of Public Health in regard to Chapman Global Health Center. On 1/11/2022, the Department received an email from public health indicating “The department was unable to substantiate the complaint allegation and found no violations of the regulation.”

Interview conducted with Administrator on 12/02/2021 indicated Public Health investigator was advised by Chapman Global Medical Center that R1 had Thrombocytopenia which can cause the resident to bruise easily. Two (2) of two (2) Caregivers interviewed stated that R1 is known for self injurious and wandering behavior. Both caregivers interviewed deny seeing any staff work with R1 in a rough or aggressive manner. R1’s family member denies any concern with care at the facility. The investigation did not produce evidence and information to support an allegation of physical abuse. Therefore, the allegation is deemed unsubstantiated, meaning that although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with and a copy of this report was provided to facility.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly Lyman	TELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 2