345002805-10-17-2023-59-AS-LMUZ-CWRQJY-20231019121331

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 345002805
Report Date: 10/17/2023
Date Signed: 10/17/2023 12:27:01 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
08/17/2023 and conducted by Evaluator Talwinder Bains

COMPLAINT CONTROL NUMBER: 59-AS-20230817140539

FACILITY NAME:	CARLTON SENIOR LIVING ORANGEVALE		FACILITY NUMBER:	345002805
ADMINISTRATOR:	AMANDA SMITH WOLTHUIS		FACILITY TYPE:	740
ADDRESS:	8773 OAK RD		TELEPHONE:	(916) 988-2200
CITY:	ORANGEVALE	STATE: CA	ZIP CODE:	95662
CAPACITY:	136	CENSUS: 78	DATE:	10/17/2023
		UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Administrator, Amanda Smith		TIME COMPLETED:	12:40 PM

ALLEGATION(S):

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Resident sustained unexplained injuries while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced on 10/17/23 to deliver complaint findings for above allegation. LPA met with administrator Amanda Smith and explained the purpose of the visit.

The department conducted records review ,facility observations and interviews to investigate the complaint.

**Report continued on LIC9099-C**

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder Bains	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2023

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 59-AS-20230817140539

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: CARLTON SENIOR LIVING ORANGEVALE	FACILITY NUMBER: 345002805
	VISIT DATE: 10/17/2023

NARRATIVE

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*** Report continued from 9099........

Allegation-- Resident sustained unexplained injuries while in care.

LPA conducted interviews which included residents, administrator and facility staff. LPA also reviewed facility and medical records regarding R1. Record review and interviews indicated that R1 sustained unexplained injuries while in care. These injuries were partly explained by self-injury behavior on the part of R1, who has advanced dementia and R1s medical condition. Facility staff noticed wounds on R1s leg/shin around 08/09/23 and notified R1s doctor and responsible party (RP). EMS was called to seek medical treatment for R1 but R1 denied transport denied by R1s RP who wanted only first aid given at facility. Facility reached out to R1s primary care doctor multiple times regarding these wounds and had a virtual appointment on 08/22/23 and seen by dermatologist on 08/31/23. R1s doctor did not order any home health staff to take care of these wounds and ordered to be treated at facility by facility professional staff (nurses). Additionally, LPA found out that staff was using Hoyer Lyft with 2 persons assist to transfer R1 from bed to wheelchair as ordered by R1s doctor without any issues.

From all this gathered information, it has been concluded that R1 sustained unexplained injuries while in care due to their medical condition and not due to lack of care and supervision by facility staff. Therefore, this allegation is UNSUBSTANTIATED. A finding that the complaint allegations is UNSUBSTANTIATED means that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

No citations were issued today. Exit meeting conducted.
A copy of this report has been provided to the facility.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder Bains	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2023

LIC9099 (FAS) - (06/04)

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