342701213-9-10-2024-27-AS-KHOS-D93TU7-20240913150153

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342701213
Report Date: 09/10/2024
Date Signed: 09/10/2024 03:56:26 PM

Unfounded

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
09/05/2024 and conducted by Evaluator Victoria Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20240905163918

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: 153	DATE:	09/10/2024
		UNANNOUNCED	TIME BEGAN:	03:15 PM
MET WITH:	Kasie Wimmer		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Staff mismanaged resident medication
Staff did not obtain a hospice care plan for resident
Staff did not maintain a comfortable temperature for resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to open the initial investigation of the above mentioned allegations on 9/10/24 at 3:15p. LPA met with Kasie Wimmer and stated the purpose of the visit.

LPA obtained information that the resident does not reside at this facility.

Based on interview with Exective Director/Administrator Kasie Wimmer the allegation(s) are deemed Unfounded."The allegation is UNFOUNDED, meaning that the allegation was false, could not have happened and/or was without a reasonable basis. This Department has therefore dismissed the complaint." Per California Code of Regulations, no deficiencies were observed or cited. Exit interview held, and a copy provided.

Unfounded

Estimated Days of Completion: 1

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Victoria Brown	TELEPHONE: (209) 814-1955
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024

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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