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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700988
Report Date: 08/11/2022
Date Signed: 08/11/2022 11:46:15 AM


Document Has Been Signed on 08/11/2022 11:46 AM - 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: 131DATE:
08/11/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Manny DirarTIME COMPLETED:
12:00 PM
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On August 11, 2022 at 10:20 AM Licensing Program Analyst (LPA) Chris Hopkins conducted an unannounced case management inspection to follow up on an incident regarding financial theft involving a resident (R1), which occurred from 6/27/22 to 7/15/22 totaling $1,139.53. LPA met with Associate Director Manny Dirar and stated the purpose of this inspection.

Resident 1(R1) has a 12 hour companion from an outside agency named Accent. R1 is on hospice and is a fall risk, so R1's door is kept open often times. Carlton Senior Living staff are investigating this matter with the Accent as well as their own staff. R1's Financial POA has cancelled R1's credit card that was compromised. POA did not want to pursue further action. Carlton Senior Living staff have filed a police report since the total of theft was $1,139.53, and also has contacted Ombudsman and Adult Protective Services. Manny Dirar has stated there will be an in-service training for his staff.

No deficiencies were observed pursuant to Title 22 rules and regulations, Health and Safety Codes.

Exit interview 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: 08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/11/2022
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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