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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701213
Report Date: 07/01/2026
Date Signed: 07/01/2026 07:39:49 PM

Document Has Been Signed on 07/01/2026 07:39 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:CARLTON SENIOR LIVING SACRAMENTOFACILITY NUMBER:
342701213
ADMINISTRATOR/
DIRECTOR:		WIMMER, KASIEFACILITY TYPE:
740
ADDRESS:1075 FULTON AVENUETELEPHONE:
(916) 971-4800
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY: 185CENSUS: 128DATE:
07/01/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Rose De La Garza, Memory Care Director/DesigneeTIME VISIT/
INSPECTION COMPLETED:
05:30 PM
NARRATIVE
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On 07/01/26, Licensing Program Analyst (LPA) Kimberly Viarella conducted a case management visit today to address the deficiencies learned through complaint investigation # 27-AS-20250416092323. This case management took place immediately following the delivery of the findings for the above complaint. LPA met with Memory Care Director/ Designee, Rose De La Garza.

Residents' (R1 and R3) hearing aids were not safeguarded and were lost or destroyed. This deficiency was cited on the LIC 809D page.

A reappraisal was not conducted for R1 when their incontinent care needs increased. Care plans for R1 and R3 also not reflect the need for residents to have assistance with charging and putting on their hearing aids.

This deficiency has been cited on the LIC 809D page.

The facility ran out of incontinent care products which directly impacted resident incontinent care. This deficiency has been cited on the LIC 809D page.

LPA and the Memory Care Director discussed the deficiencies and corresponding plans of correction. According to the California Code of Regulations, Title 22, no other deficiencies were cited during today's visit, a copy of this report along with APPEAL RIGHTS was provided and an exit interview was conducted with De La Garza.

NAME OF LICENSING PROGRAM MANAGER: Stephen Richardson
NAME OF LICENSING PROGRAM ANALYST: Kimberly Viarella
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/01/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 07/01/2026 07:39 PM - It Cannot Be Edited


Created By: Kimberly Viarella On 07/01/2026 at 02:53 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: CARLTON SENIOR LIVING SACRAMENTO
FACILITY NUMBER: 342701213

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/31/2026
Section Cited
CCR
87218

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87218 Theft and Loss (a) The licensee shall ensure an adequate theft and loss program...(2) A licensee who fails to make reasonable efforts to safeguard resident property, shall reimburse...

The above requirement was not met as evidnced by:



The facility did not
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Facility will conduct an in-service regarding theft and loss policy. Families will be educated regarding the theft and loss policy in the monthly newsletter and know that they are able to file a loss report with management. A copy of the inservice with signature sheets and a copy of
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Based on interviews F1 and F3's hearing aids were lost and Interviews with H1 and the Directors of Memory Care and Maintenance stated hearing aids were found in the laundry. These items were not safeguarded and no loss reports were completed. This posed a potential risk to the health, safety and personal rights of residents in care.
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the news letter will be sent to CCL by 07/31/26.
Type B
07/30/2026
Section Cited
CCR87625(a)(1)(D)

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(a) The licensee shall be permitted to accept or retain…manageable…incontinence condition under the following circumstances: (1)The condition…(D) The use of incontinent care products.
The above requirement was not met as evidenced by:
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Facility will condcut an in-service with staff to educate them to the multiple resources available at this location to ensure that residents incontinent care needs are met.
Facility will send resource sheet with signatures of attendees to CCL by 07/31/26.
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Based on a review of records and an interview with S8, it was documented that R1 had run out of adult briefs and wipes. This posed a potential risk to the health, safety ad personal rights of residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Stephen Richardson
NAME OF LICENSING PROGRAM MANAGER:
Kimberly Viarella
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/01/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/01/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/01/2026 07:39 PM - It Cannot Be Edited


Created By: Kimberly Viarella On 07/01/2026 at 03:10 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: CARLTON SENIOR LIVING SACRAMENTO
FACILITY NUMBER: 342701213

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/01/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/02/2026
Section Cited
CCR
874634(a)

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Reappraisals (a) The pre-admission… shall be updated in writing as frequently as necessary ...

The above requirement was not met as evidenced by:
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Facility will condcut an audit of all care plans in memory care starting with those residents with hearing aids and classes to make them more person-centered. A draft of the audit starting with the residents who have hearing aids and glasses followed by the remainder of
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The care plans for R1 were not updated to include their increased incontinent care needs. The plan also did not incude the need for staff to charge and safeguard R1's hearing aids. This posed an immediate risk to the health, safety and personal rights of residents in care.
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the residents in memory care will be emailed to CCL by close of business on 07/02/26.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Stephen Richardson
NAME OF LICENSING PROGRAM MANAGER:
Kimberly Viarella
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/01/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/01/2026


LIC809 (FAS) - (06/04)
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