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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701213
Report Date: 07/07/2025
Date Signed: 07/07/2025 03:06:45 PM

Substantiated


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
03/24/2025 and conducted by Evaluator Arielle Pascua
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250324141824
FACILITY NAME:CARLTON SENIOR LIVING SACRAMENTOFACILITY NUMBER:
342701213
ADMINISTRATOR:WIMMER, KASIEFACILITY TYPE:
740
ADDRESS:1075 FULTON AVENUETELEPHONE:
(916) 971-4800
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY:185CENSUS: DATE:
07/07/2025
UNANNOUNCEDTIME BEGAN:
02:33 PM
MET WITH:Rose Dela Garza TIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Licensee did not ensure facility was adequately treated for pests
Staff did not ensure resident was provided with bathing services
Staff did not ensure residents room was kept in clean sanitary conditions
INVESTIGATION FINDINGS:
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On 07/07/2025, Licensing Program Analysts (LPA) Arielle Pascua and Triel Lindstrom arrived unannounced to this facility to conduct a complaint visit. LPA met with FDR Rose Dela Garza and explained the purpose of the visit. The purpose of this visit was to deliver complaint findings for the allegations above.

Current census was 131. A brief interview with FDR was conducted.

Allegation: Licensee did not ensure facility was adequately treated for pests.
It was alleged that the licensee failed to ensure the facility was adequately treated for pests. During the course of the investigation, the department conducted interviews, made observations, and reviewed facility records. On March 27, 2025, Licensing Program Analysts (LPAs) Kimberly Viarella and Sommer Hayes conducted observations in three adjacent bedrooms. No evidence of pests was found in one of the rooms; however, further inspection of the remaining two bedrooms revealed several small, flat, black bugs along the baseboards and behind the couch.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2025
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 6
Control Number 27-AS-20250324141824
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: 07/07/2025
NARRATIVE
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It was discovered that the infested bedroom had not been included in the facility’s routine pest control services. The maintenance director added the room to the pest control list at the time of the inspection. Staff interviews revealed that photos of additional bugs had been submitted to management earlier, but no action was taken at that time. Additionally, a review of pest control invoices from October 2024 through March 2025 showed that services were limited to a single bedroom and focused solely on treating for German roaches. No pest control treatments or follow-up inspections were conducted in adjacent rooms during that period. Based on the information gathered, the licensee did not ensure that the facility adequately treated for pests.

Allegation: Staff did not ensure resident was provided with bathing services

It was alleged that facility staff failed to ensure the resident (R1) received appropriate bathing services. During the investigation, the Licensing Program Analyst (LPA) conducted staff interviews and reviewed facility records. Staff initially reported that R1 had stopped taking showers. The facility stated they had agreed with R1’s responsible party to continue offering showers in an effort to assist R1, prior to formally updating the care plan. Staff claimed that attempts were made to offer showers, but that R1 continued to refuse them. However, a review of R1’s shower logs revealed no documentation indicating that showers were offered or refused. When questioned further, staff acknowledged that showers had not actually been offered to R1, despite previous claims. Based on the evidence obtained, it was determined that staff did not ensure that R1 was provided with bathing services, as required.

Allegation: Staff did not ensure residents room was kept in clean sanitary conditions

It was alleged that staff did not ensure residents room was kept in clean sanitary conditions. During the investigation, LPA conducted observations to assist with this allegations. Based on observations made it was found during a facility visit on 03/27/2025 by LPAs Viarella and Hayes it was observed that there was pet feces and bugs all throughout the room. In addition, items were asked to be moved to inspect other items of the rooms because there was limited space to move through all the items places throughout the room. It was also observed that the sofa against the wall had bugs, boxes, and other items such as wrappers and bags stored behind it. During this visit, LPAs had to ask maintenance to help assist move the items to inspect throughout the room and behind the sofa. Based on the information gathered, the staff did not ensure residents room was kept in sanitary conditions.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 27-AS-20250324141824
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: 07/07/2025
NARRATIVE
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As a result of this investigation, this LPA found the allegations to be SUBSTANTIATED - A finding that the complaint was Substantiated meant that the allegation was valid because the preponderance of the evidence standard had been met.

The following deficiencies were cited on the following LIC 9099-D pursuant to Title 22 Rules and Regulations, Division 6 and Health and Safety Codes.

An Exit Interview was conducted and a copy of this report and appeals rights was provided to the facility at the end of this visit.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 6
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
03/24/2025 and conducted by Evaluator Arielle Pascua
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250324141824

FACILITY NAME:CARLTON SENIOR LIVING SACRAMENTOFACILITY NUMBER:
342701213
ADMINISTRATOR:WIMMER, KASIEFACILITY TYPE:
740
ADDRESS:1075 FULTON AVENUETELEPHONE:
(916) 971-4800
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY:185CENSUS: 131DATE:
07/07/2025
UNANNOUNCEDTIME BEGAN:
02:33 PM
MET WITH:Kasie Wimmer TIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff did not ensure resident was provided clean linens
Personal rights violation
INVESTIGATION FINDINGS:
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On 07/03/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct a complaint visit. LPA met with FDR Rose Dela Garza and explained the purpose of the visit. The purpose of this visit was to deliver complaint findings for the allegations above.

Current census was 131. A brief interview with FDR was conducted.
Allegation: Staff did not ensure resident was provided clean linens
It was alleged that staff did not ensure resident was provided clean linens. During the investigation, it was found that R1 often refused housekeeping access to their room, as they were hesitant to allow staff inside. However, staff reported that on some days, R1 did permit housekeeping to enter to assist with cleaning and laundry. During these days housekeeping would try their best to ensure that the resident’s room was as clean as possible which included providing clean linens. Based on the information gathered, there was not sufficient evidence to show that the resident was not provided clean linens.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 27-AS-20250324141824
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: 07/07/2025
NARRATIVE
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Allegation: Personal rights violation.
It was alleged that the facility had a personal rights violation. During the investigation and interview with 5 residents and 5 staff members were conducted. 5 out 5 residents report no issues with the staff or the facility at this time. 5 out 5 staff members deny that they violate any resident rights and are aware of their rights at the facility. Based on this information, there is not sufficient evidence to prove that the facility violated the rights of a resident.

As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred.
There were no deficiencies observed or cited at this time.
An exit interview was conducted and a copy of this report was provided to the facility at the end of this visit.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 27-AS-20250324141824
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/07/2025
Section Cited
CCR
87303(a)
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(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.
This was not met as evidenced by:
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Facility staff states that a statement of correction that outlines a plan to correct housekeeping documentation and pest control services by 08/07/2025.
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Based on observation, interview, and record review the licensee did not ensure that the residents room was kept in a clean and sanitary manner. It was learned that the facility did not obtain pest services or maintain the room in a sanitary manner. This poses a potential health,safety, and personal rights risks to persons in care.
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Type B
08/07/2025
Section Cited
CCR
87464(f)(4)
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(4) Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living such as dressing, eating, bathing and assistance with taking prescribed medications, as specified in Section 87608, Postural Supports.
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Facility staff states that a statement of correction that outlines a plan to correct bathing services by 08/07/2025.
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This is not met as evidenced by: Based on interview and records review the licensee did not ensure that R1 was provided showering services. This poses an potential health, safety, and personal rights risks to persons 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.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6