342700988-12-17-2021-27-AS-CACL-CACSEH-20220104124846

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700988
Report Date: 12/17/2021
Date Signed: 12/17/2021 03:37:46 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

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

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/16/2021 and conducted by Evaluator Christopher Hopkins-Clarke

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20211116130706

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: 175	DATE:	12/17/2021
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Marybel Caro		TIME COMPLETED:	03:40 PM

ALLEGATION(S):

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-Staff person intentionally withholds medications from residents
-Staff person spends his shift sleeping.
-Staff person refused to assist resident with going to the bathroom.
-Staff person is verbally abusive to residents
-Staff did not respond to resident's call for assistance

INVESTIGATION FINDINGS:

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On December 17, 2021 at 1:30pm, Licensing Program Analyst (LPA) Chris Hopkins conducted an unannounced facility visit in regards to a complaint investigation with the above allegations. LPA met with Administrator Marybel Caro and explained the purpose of today's visit.

Regarding the allegation of Staff person intentionally withholds medications from residents, the Department found the following: based on interviews it was determined that Staff 1 (S1) was following doctors orders regarding this medication. The complainant, who did not know the procedures that take place prior to giving out medication, assumed S1 just wasn't giving this resident their medication, when in fact that resident had just received medication and was asking for more. S1, following doctors orders, explained to this resident that there needed to be more time between doses.

Report continued on LIC9099-C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Christopher Hopkins-Clarke	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20211116130706

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 12/17/2021

NARRATIVE

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Regarding the allegation of Staff person spends his shift sleeping, the Department found the following: based on interviews with 4 staff (Night and NOC shift), all 4 stated that they have never seen S1 sleeping on the job. S1 was always the nurse in charge and available during all of NOC shift.

Regarding the allegation of Staff person refused to assist resident with going to the bathroom, the Department found the following: based on interviews it was determined that when a resident needs help using the bathroom, whatever staff that is around will help them. Multiple staff have stated S1 is always there to help and they have never seen S1 refuse to help anyone.

Regarding the allegation of Staff person is verbally abusive to residents, the Department found the following: based on interviews with staff and Resident 1's (R1) responsible party, and other residents it was determined that S1 has never verbally abused R1 or any resident. S1 has been with the company for 5 years and has never had 1 incident or complaint against her/him.

Regarding the allegation of Staff did not respond to resident's call for assistance, the Department found the following: based on interviews it was determined that the complainant was calling for assistance and not a resident. Due to a mixup with staff walkie-talkies, the complainant and S1 were not on the same channel. Each staff also carries a work cell phone that has S1's number already stored in it. If this matter was urgent the complainant had the opportunity to call S1 on her/his cell phone. Once S1 realized her/his walkie-talkie was on the wrong channel he switched it to the right channel.

LPA has deemed the five allegations mentioned above as UNSUBSTANTIATED. Although the allegations may have happened and/or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview conducted with Administrator Marybel Caro. A copy of this report was left with Administrator upon exit.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Christopher Hopkins-Clarke	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021

LIC9099 (FAS) - (06/04)

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