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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306000295
Report Date: 05/23/2025
Date Signed: 05/23/2025 10:01:31 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
08/05/2024 and conducted by Evaluator Cassandra Mikkelson
COMPLAINT CONTROL NUMBER: 22-AS-20240805115109
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: DATE:
05/23/2025
UNANNOUNCEDTIME BEGAN:
09:27 AM
MET WITH:Elena WeinerTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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Resident sustained severe injuries while care
INVESTIGATION FINDINGS:
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On 05/23/2025, Licensing Program Analyst (LPA) Cassandra Mikkelson contacted the licensee via phone and email to deliver final findings regarding a complaint that was received on 08/05/2024.

**Report continued on 9099- C page**
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2025
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-20240805115109
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 05/23/2025
NARRATIVE
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Resident sustained severe injuries while care

Interviews conducted with Administrator indicated that Resident R1 was considered a fall risk so staff monitored closely and escort R1 when they walk around the facility. Interviews with care staff indicated that R1 had fallen on 7/30/2024 while in the dining room. R1 attempted to stand on their own but was unable and they fell to a sitting position on the floor. Staff were quick to help R1 and check for injuries. Records reviewed indicated that R1 was a fall risk and needed assistance with moving about the facility and needed overnight observation due to wandering risk. Incident reports reviewed indicated that R1 had bruising/discoloration on forehead and right eye when R1 was admitted to facility on 07/28/2024. R1 also had a fall on 07/30/2024 which both physician and responsible party were notified about. Facility staff quickly and appropriately assisted R1. Based on interviews conducted and records reviewed, the allegation resident sustain sever injuries while in care is unsubstantiated.

Licensee was advised a copy of this report will be sent via certified mail. Two copies of this report will be sent. The Licensee is to sign and return a copy to the Orange County Regional office.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:

DATE: 05/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2