342700988-7-21-2021-27-AS-AMAZ-C55SPH-20210721140309

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 342700988
Report Date: 07/21/2021
Date Signed: 07/21/2021 02:03:20 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME:	CARLTON SENIOR LIVING SACRAMENTO		FACILITY NUMBER:	342700988
ADMINISTRATOR:	CARO, MARYBEL		FACILITY TYPE:	740
ADDRESS:	1071 & 1075 FULTON AVENUE		TELEPHONE:	(925) 370-6220
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95825
CAPACITY:	284	CENSUS: 153	DATE:	07/21/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Marybel Parker		TIME COMPLETED:	02:00 PM

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Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct a prelicensing visit on 07/21/2021 at 8:50 AM. LPA met with Marybel Parker and stated the purpose of today’s visit. LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations.

Marybel Parker is the Executive Director of 1071 and 1075 buildings. Emanuel Dirar is the Associate Director of 1071 and 1075 buildings.

The facility is licensed for 124 ambulatory residents and 160 non-ambulatory residents, which the total capacity is 284. There are currently 126 residents who reside at the 1075 building, which 7 residents are receiving hospice services. There are currently 47 residents who reside at the 1071 building, which 5 residents are receiving hospice services.

The LPA toured 1071 and 1075 buildings with Marybel Parker the on 07/21/2021 at 9:30 AM. The 1071 and 1075 buildings were clean, safe, and in good repair. The exterior of facilities were clear of debris. All outdoor passageways were kept free from obstruction. The 1075 building has a water fountain, which has emergency shut off, and there is no pooled water. Water fountain has a water release catch, which drains the water, so there is not pooled water.

The facilities' toilets, hand washing, and bathing areas were sanitary and operational. The residents’ bedrooms are in good repair, and are furnished with a chair, dresser, lighting, bed, and night stand table. The facilities' have space and equipment for laundry. The facilities' common areas are well maintained. LPA inspected kitchen areas for the ability to prepare and store food. The LPA observed the required (2) two-day perishable and (7) seven-day non-perishable food at 1071 and 1075 buildings.

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SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina Martinez	TELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: CARLTON SENIOR LIVING SACRAMENTO	FACILITY NUMBER: 342700988
	VISIT DATE: 07/21/2021

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Medications were stored in a locked cabinet. The facility uses an electronic software program (QuickMAR) to record all dispensed medication . The facilities have a first aid kit. Both facilities have employee and resident files. The last fire inspection was on 07/01/2021.

The following area will need further follow up: hospice waiver. LPA Martinez will follow up on hospice waiver approval documentation, and LPA Martinez will return at a later date and time to complete the prelicensing visit. No deficiencies were cited at this prelicensing visit, and a exit interview was conducted with Marybel Parker.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina Martinez	TELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021

LIC809 (FAS) - (06/04)

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