345002805-9-23-2022-25-AS-LMUZ-CJNT7G-20220927142841

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 345002805
Report Date: 09/23/2022
Date Signed: 09/23/2022 09:18:36 AM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/01/2022 and conducted by Evaluator DeAnna Williams-Lyons

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20220601092014

FACILITY NAME:	CARLTON SENIOR LIVING ORANGEVALE		FACILITY NUMBER:	345002805
ADMINISTRATOR:	SCHUMANN, LISA		FACILITY TYPE:	740
ADDRESS:	8773 OAK RD		TELEPHONE:	(916) 988-2200
CITY:	ORANGEVALE	STATE: CA	ZIP CODE:	95662
CAPACITY:	136	CENSUS: 71	DATE:	09/23/2022
		UNANNOUNCED	TIME BEGAN:	08:33 AM
MET WITH:	Olivia Sterba, Executive Assistant		TIME COMPLETED:	09:34 AM

ALLEGATION(S):

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Facility has a scabies outbreak.

INVESTIGATION FINDINGS:

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On September 23, 2022, Licensing Program Analyst (LPA) De Anna Williams Lyons arrived unannounced to deliver findings for complaint # AS-25- AS-20220601092014. LPA met with, Olivia , Sterba, Executive Assistant and informed her the reason for the visit.

Prior to initiating the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms and completed a facility risk assessment. LPA ensured she applied hand sanitizer before entering the facility and a N-95 mask was worn for Personal Protective Equipment.

Facility staff observed numerous residents with rashes on their bodies. The facility reached out to residents’ physicians who initially declined conducting skin scrapes of residents to test for scabies. On September 18, 2022, skin scrapes were conducted which revealed the rashes were negative for scabies.

To continue see 9099-C...

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons	TELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2022

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 25-AS-20220601092014

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: CARLTON SENIOR LIVING ORANGEVALE	FACILITY NUMBER: 345002805
	VISIT DATE: 09/23/2022

NARRATIVE

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LPA investigated the allegation of “facility has scabies outbreak”. LPA reviewed resident and facility records and interviewed 2 staff regarding the outbreak. LPA interviewed care director in which they stated there has not been a scabies outbreak within the facility.
LPA interviewed the executive director in which she stated there has never been an outbreak at the facility.

Based on interviews conducted, a review of staff and resident records, and the executive director provided documentation that residents were examined and there was no diagnosis of scabies at the facility, the allegation that the facility has a scabies outbreak is UNFOUNDED, meaning the allegation was false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted and a copy of this report was given to Olivia.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons	TELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2022

LIC9099 (FAS) - (06/04)

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