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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000295
Report Date: 03/29/2022
Date Signed: 03/29/2022 04:18:29 PM


Document Has Been Signed on 03/29/2022 04:18 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
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: 45DATE:
03/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Elena WeinerTIME COMPLETED:
02:50 PM
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Licensing Program Analysts (LPAs) Kimberly Lyman and Andrea Mendivil conducted an unannounced visit for the purpose of conducting a required/ annual visit. LPAs were greeted and granted entry into the facility and explained the reason for the visit. Administrator Elena Weiner has a current administrator certificate that expires on 07/20/2023.

At 12:50pm LPAs toured the facility with Administrator Elena Weiner. Facility has 45 residents in care during today's visit with 7 residents on hospice care . Facility consists of Memory Care. LPAs observed a library and salon. LPAs observed residents relaxing in the facility. All residents appeared happy and well taken care of. Facility appears clean and sanitary. All resident rooms had the required elements as well as restrooms stocked with soap/ sanitizer. Rooms are single occupancy and double occupancy. Facility screens all visitors to the facility and LPAs observed the screening/ sanitizing station in the facility. Facility utilizes a visitor sign in sheet. Facility takes resident and staff temperatures daily and documents. LPAs observed the first aid kit has all required items. LPAs observed multiple outside visitation areas. LPAs observed the medication room and facility uses handwritten medical records for medication management. Facility has a plan for covid testing residents and staff as needed as well as a plan for isolation and quarantine. All residents and staff are vaccinated for Covid-19.
LPAs consulted with Administrator on the importance of posting the "Let Us No" in the entrance of facility in regulation size, 20"X26"

No deficiencies noted during today's visit. An exit interview was 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: 03/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/29/2022
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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