342701212-4-6-2023-27-AS-KHOS-CR8GDX-20230425051551

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342701212
Report Date: 04/06/2023
Date Signed: 04/06/2023 09:39:44 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 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
03/27/2023 and conducted by Evaluator Brandon Panariello

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20230327095639

FACILITY NAME:	CARLTON SENIOR LIVING SACRAMENTO ATRIUM		FACILITY NUMBER:	342701212
ADMINISTRATOR:	KASIE WIMMER		FACILITY TYPE:	740
ADDRESS:	1071 FULTON AVENUE		TELEPHONE:	(916) 971-4800
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95825
CAPACITY:	99	CENSUS: 83	DATE:	04/06/2023
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Kasie Wimmer (Ex. Director)		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Facility fire alarm system in disrepair

INVESTIGATION FINDINGS:

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Licensing Program Analysst (LPA) Brandon Panariello and Kevin Gould conducted an unannounced complaint inspection at Carlton Senior Living Sacramento Atrium (RCFE) on 4/6/23 at 08:30 to inform the licensee of complaint allegation/s mentioned above.

During this investigation LPA Panariello interviewed Kasie Wimmer (Ex. Director). Based on the interviews and statements obtained during the investigation process, the allegations have been corroborated because it was confirmed that the backup fire alarm was not operating correctly and in accordance with their fire clearance. The second line to the fire alarm system was not working. ATT came out and fixed the problem. The facility was on fire watch for less than 24 hours. Sac Metro Fire stated that it was repaired on 3/25/23.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) -26-4723
LICENSING EVALUATOR NAME: Brandon Panariello	TELEPHONE: 323-558-2130
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

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

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 27-AS-20230327095639

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: CARLTON SENIOR LIVING SACRAMENTO ATRIUM	FACILITY NUMBER: 342701212
	VISIT DATE: 04/06/2023

NARRATIVE

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The Department has determined, based on the preponderance of the evidence obtained during this investigation, that the allegation of fire clearance is substantiated but if any additional information is received this complaint can be amended and the finding can be changed.

The following deficiencies are cited per California Code Regulation, TITLE 22.

Exit interview was conducted with the facility administrator. Appeal Rights were issued, and a copy of this report was left at the facility.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) -26-4723
LICENSING EVALUATOR NAME: Brandon Panariello	TELEPHONE: 323-558-2130
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 27-AS-20230327095639

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: CARLTON SENIOR LIVING SACRAMENTO ATRIUM	FACILITY NUMBER: 342701212
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/06/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed Type A 04/07/2023 Section Cited CCR 87202(a)	1 2 3 4 5 6 7	Fire Clearance: All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the	1 2 3 4 5 6 7	Facility maintenance staff and fire marhsall have verified that the fire alarm has been repaired and is now fully operational.
	8 9 10 11 12 13 14	applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. This requirement was not met as evidenced by Sacramento County Fire Marshall and facility staff confrimed that the backup fire alarm was not operational due to an ATT error, which poses an immediate health, safety, and personal rights risk to residents in care.	8 9 10 11 12 13 14
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	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) -26-4723
LICENSING EVALUATOR NAME: Brandon Panariello	TELEPHONE: 323-558-2130
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

LIC9099 (FAS) - (06/04)

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