342701213-6-20-2024-27-AS-LKIG-D6YNFN-20240708102549

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342701213
Report Date: 06/20/2024
Date Signed: 06/20/2024 04:02:29 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/06/2024 and conducted by Evaluator Michael Bilger

COMPLAINT CONTROL NUMBER: 27-AS-20240506161153

FACILITY NAME:	CARLTON SENIOR LIVING SACRAMENTO		FACILITY NUMBER:	342701213
ADMINISTRATOR:	WIMMER, KASIE		FACILITY TYPE:	740
ADDRESS:	1075 FULTON AVENUE		TELEPHONE:	(916) 971-4800
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95825
CAPACITY:	185	CENSUS: 142	DATE:	06/20/2024
		UNANNOUNCED	TIME BEGAN:	02:50 PM
MET WITH:	Kasie Wimmer		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Facility staff sexually abused resident in care

INVESTIGATION FINDINGS:

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On 6-20-24 at 2:50pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver and discuss findings for the complaint allegation noted above. LPA met with Administrator Kasie Wimmer and explained the purpose of the visit. During this investigation, the Department conducted interviews with resident1 (R1) and additional witness. The department also reviewed facility file documentation including SOC 341 abuse report, resident and services agreement, physician's report for R1, Activities of Daily LIving (ADL) questionnaire for physician review, resident health identification information, key lock audits, observation notes dated 4-2-2024 to 5-6-2024, resident roster, staffing roster, staff schedules for April 2024 to May 2024, and assisted living/memory care staff contact information.
Based on interviews and record reviews, it was determined that R1 was unable to identify a suspect male or female. Interviews conducted further revealed facility staff performed duties to R1 including checking the location of R1’s call button and checking R1 for any needed incontinence care.

{Cont. on 9099C}

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Michael Bilger	TELEPHONE: (916) 862-4722
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024

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-20240506161153

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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 SACRAMENTO	FACILITY NUMBER: 342701213
	VISIT DATE: 06/20/2024

NARRATIVE

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Additionally, interviews further revealed that the information received did not result in a credible source to determine if facility staff sexually abused a resident in care. As a result, the allegation is UNSUBSTANTIATED. A finding of unsubstantiated means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted with Administrator and a copy of this report was provided to Administrator. Appeal rights provided. LIC 811 provided.

SUPERVISOR'S NAME: Liza King	TELEPHONE: (650) 676-0442
LICENSING EVALUATOR NAME: Michael Bilger	TELEPHONE: (916) 862-4722
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2024

LIC9099 (FAS) - (06/04)

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