345002805-3-7-2024-59-AS-LMUZ-D3DVGC-20240315162517

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 345002805
Report Date: 03/07/2024
Date Signed: 03/07/2024 12:29:47 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
02/06/2024 and conducted by Evaluator Talwinder Bains

COMPLAINT CONTROL NUMBER: 59-AS-20240206091615

FACILITY NAME:	CARLTON SENIOR LIVING ORANGEVALE		FACILITY NUMBER:	345002805
ADMINISTRATOR:	MIRIAM FARIS		FACILITY TYPE:	740
ADDRESS:	8773 OAK RD		TELEPHONE:	(916) 988-2200
CITY:	ORANGEVALE	STATE: CA	ZIP CODE:	95662
CAPACITY:	136	CENSUS: 83	DATE:	03/07/2024
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Administrator, Miriam Faris		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Staff mismanaged resident medication.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced on 03/07/24 to deliver complaint findings for above allegation. LPA met with administrator Miriam Faris 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: 03/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024

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 59-AS-20240206091615

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: 03/07/2024

NARRATIVE

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

Allegation- Staff mismanaged resident medication.

Based on the department's investigation, including facility observations, record review, and interviews with staff and residents, it has been concluded that the allegation made against the facility regarding medication administration is unsubstantiated. The interviews with both staff and residents indicated that medications were being given to resident, R1 on time, and the facility maintained proper logs and documentation for all medications according to physician's orders. Residents interviews confirmed that they were receiving their scheduled medications in a timely manner, and the staff were not mismanaging their medications. Therefore, the allegation is determined to be without basis or evidence and is therefore considered 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 per CCR, Title 22 Regulations. . Exit meeting conducted with administrator.
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: 03/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024

LIC9099 (FAS) - (06/04)

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