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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700988
Report Date: 07/27/2022
Date Signed: 07/27/2022 04:10:31 PM


Document Has Been Signed on 07/27/2022 04:10 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, 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: 185DATE:
07/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Manny DirarTIME COMPLETED:
04:20 PM
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On July 27, 2022 at 2:45PM Licensing Program Analyst (LPA) Chris Hopkins arrived at Carlton Senior Living Sacramento for the purpose of conducting an unannounced required 1 year annual inspection. LPA met with Associate Director, Manny Dirar and together conducted a tour of the home.

LPA and Associate Director evaluated the physical plant to ensure the health and safety of the residents in care. Areas inspected are including but not limited to the kitchen, resident bedrooms, resident bathrooms, social areas and outdoor areas. LPA observed the facility to be free of odor, clean and in good repair. LPA observed that rooms are equipped with the required furniture and sufficient lighting throughout the facility.

LPA measured the water temperature, temperature measured at 112 degrees F which meets the 105-120 degree Fahrenheit regulation. LPA observed sufficient seven-day non-perishable and two-day perishable food supplies. Fire extinguishers and smoke and carbon monoxide detectors are in compliance with fire safety. First aid kit was checked and is complete. LPA observed centrally stored medications and toxins kept locked and inaccessible to clients. LPA reviewed Fingerprint clearance and associations to the facility. The facility submitted a LIC 808 mitigation plan, which was approved. The facility has central entry point and has implemented screening and sign in procedures at the front desk area. The facility conducts routine symptom screening for employees, residents, and visitors. LPA observed the facility to have hand washing signs, COVID-19 informational signs and social distancing signs posted throughout the facility. The facility has a designated infection control lead.

Per California Code of Regulations, Title 22 there were no deficiencies cited during today's inspection. An exit interview was conducted, and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Christopher Hopkins-ClarkeTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 07/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2022
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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