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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306000295
Report Date: 05/04/2022
Date Signed: 05/04/2022 12:38:14 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
10/04/2021 and conducted by Evaluator Kimberly Lyman
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20211004170327
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: 45DATE:
05/04/2022
UNANNOUNCEDTIME BEGAN:
12:06 PM
MET WITH:Elena WeinerTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Resident sustained unexplained bruising while in care.
Resident's diapering needs were not met.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Kimberly Lyman and Joseph Alejandre conducted an unannounced complaint visit to deliver findings on the above allegations. LPA was 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 08/23/2021, medication orders and Los Alamitos Medical Center admission paperwork dated 10/04/2021. Regarding the allegations that resident sustained unexplained bruising while in care and resident’s diapering needs were not being met, the investigation revealed the following:
Resident 1 (R1) was sent to Los Alamitos Hospital on 10/04/2021 for repeated abdominal pain. While there, it was observed the resident had unusual bruising and a soiled diaper. Per an interview conducted with the facility Administrator, R1 had been at Los Alamitos Hospital the day prior with a diagnosis of constipation. R1 had returned to the facility with an order for an enema which the facility had administered upon return and the next day. The Administrator states R1’s diaper was CONTINUED ON LIC 9099C DATED 05/04/2022
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly LymanTELEPHONE: (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-20211004170327
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
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changed right before they were transported to the hospital on 10/04/2021 per facility protocol. The Hospital contacted the Administrator questioning the soiled diaper. It was explained the resident had been given an enema per physician order and the diaper had been changed prior to being sent out. The Administrator reported facility protocol is to provide incontinence care to R1 frequently as R1 has a history of ripping off their diaper. General facility protocol for incontinence care is every two hours but, in this case, it is done more frequently. R1 was described by multiple reports as being non-compliant and combative with incontinence care.

Besides the soiled diaper, the Los Alamitos Medical Center
RN observed 10/01/2021 “Bruising of various stages on legs/ face, yellow bruising on bilateral shins. Purple bruises on left upper thigh. Patient has yellow bruising around left eye and purple bruise on upper lip to left side. Patient denies falling.” R1 stated in an interview with the hospital social worker that they tripped and fell while walking. Four (4) out of four (4) witnesses interviewed confirm R1 is combative, aggressive and throws themselves on the ground or into furniture. The Department’s interview with R1 was not completed due to R1’s verbal aggression and refusal. R1’s responsible party (RP) noted they had no concerns about the care provided by the facility. RP corroborated R1’s aggressive behavior as well as falls prior to admission into the facility. Due to conflicting information, the department is unable to corroborate allegations. Therefore, the allegations are deemed unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence.

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: 05/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2022
LIC9099 (FAS) - (06/04)
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