345002805-7-31-2024-59-AS-LMUZ-D85QFH-20240814120758

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 345002805
Report Date: 07/31/2024
Date Signed: 07/31/2024 02:07:08 PM

Unfounded

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
07/15/2024 and conducted by Evaluator Talwinder Bains

COMPLAINT CONTROL NUMBER: 59-AS-20240715093209

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: 90	DATE:	07/31/2024
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Executive Assistant, Ellaina Canady		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Facility did not follow resident's contract.
Facility is serving food to residents that is not of quality.
Facility did not issue a refund to a resident in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced on 07/31/24 to deliver complaint findings for above allegations. LPA met with Executive Assistant, Ellaina Canady 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**

Unfounded

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: 07/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024

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-20240715093209

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: 07/31/2024

NARRATIVE

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**Report continued from 9099....

Allegation- Facility did not follow resident's contract. Facility did not issue a refund to a resident in care.-UNFOUNDED

The Department conducted record review, facility’s observations, staff and resident’s interviews to investigate these allegations. Record review indicated that resident, R1 moved in to the facility on 05/09/24 and the admission agreement was signed by facility Administrator, Miriam Faris and R1s responsible party (RP) on 05/07/24. Per admission agreement, monthly charges were agreed at $6695/monthly. RP paid $5062.55 (prorated rate for May 2024) and full month payment of $6695 for June 2024. It was also noted that per signed admissions agreement, RP was required to provide a 30 days notice to move out of the facility. R1 moved out of the facility on 06/16/24. RP gave 30 days notice to facility on 06/20/24. Four (4) Staff interviews conducted on 07/18/24 indicated that R1s care needs were providing per their Needs and Service plan. From all this gathered information, it has been concluded that RP did not provide 30 days ‘move out’ notice for R1 per admission agreement, therefore the facility does not owe a refund to R1 and RP. Additionally, facility staff followed R1s care needs based on R1’s need and service plan. Based on all this information, these allegations were found to be UNFOUNDED.

Allegation- Facility is serving food to residents that is not of quality. UNFOUNDED

The Department conducted record review, facility’s observations, staff, and resident’s interviews to investigate these allegations. During facility observation on 07/18/24, it was observed during meal service that facility was providing quality food to residents and staff were supportive to resident’s dietary needs. Record review indicated that facility provides choice of different foods with daily menu and substitute /alternate items are also available during meals. Four (4) Staff interviews conducted on 07/18/24 indicated that facility was meets residents dietary needs and offer quality food on daily basis. Four (4) residents interviews conducted on 07/18/24 reflected that facility’s meal services were fine and they enjoy their daily meals. Residents expressed their satisfaction with quality of the food that is served and did not report any concerns. Based on gathered information, this allegation was found to be UNFOUNDED.

Based on the investigation, the preponderance of evidence standards has not been met. Therefore, the above all allegations is found to be UNFOUNDED. A finding that the allegations are unfounded means that the allegations are false, could not have happened, and/or is without a reasonable basis. Exit meeting conducted. A copy of this report has been provided to facility.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Talwinder Bains	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 07/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024

LIC9099 (FAS) - (06/04)

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