<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700988
Report Date: 07/29/2021
Date Signed: 07/29/2021 03:29:32 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 SACRAMENTOFACILITY NUMBER:
342700988
ADMINISTRATOR:CARO, MARYBELFACILITY TYPE:
740
ADDRESS:1071 & 1075 FULTON AVENUETELEPHONE:
(925) 370-6220
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY:284CENSUS: 153DATE:
07/29/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:Emanuel DirarTIME COMPLETED:
03:45 PM
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
Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct a follow up prelicensing visit on 07/29/2021 at 1:00 PM. LPA met with Emanuel Dirar and stated the purpose of today’s visit.

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.

LPA Martinez reviewed hospice waiver approval letter. The facility is approved for 35 hospice residents.

The applicant has passed the pre-licensing component of the application process. LPA will notify the Central Application Bureau (CAB) that the pre-licensing has been completed and passed.

Exit interview conducted and a copy of the report was given to Emanuel Dirar.

SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Avelina MartinezTELEPHONE: (916) 431-8935
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1