347002787-8-6-2020-27-AS-LMUZ-BT3NES-20200902102419

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347002787
Report Date: 08/06/2020
Date Signed: 08/06/2020 01:31:26 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/24/2020 and conducted by Evaluator Michael Hood

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20200724111330

FACILITY NAME:	CARLTON PLAZA OF SACRAMENTO		FACILITY NUMBER:	347002787
ADMINISTRATOR:	LISA SCHUMANN		FACILITY TYPE:	740
ADDRESS:	1075 FULTON AVENUE		TELEPHONE:	(916) 971-4800
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95825
CAPACITY:	185	CENSUS: 127	DATE:	08/06/2020
		UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	Lisa Schumann, Administrator		TIME COMPLETED:	01:50 PM

ALLEGATION(S):

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Facility is in disrepair

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Michael Hood contacted Administrator Lisa Schumann via telephone to deliver findings for a complaint investigation of violation of physical plant. This visit was conducted via telephone due to COVID-19 and precautionary measures.

Allegation: Facility is in disrepair – Unsubstantiated

During a tele-visit conducted on 7/30/2020 by LPA, holes were observed in the hallway ceilings outside of residents’ rooms. Administrator stated that work had been in place for installing Wi-Fi services at the facility, but due to COVID-19 pandemic the work had been put on hold. LPA did not observe any hanging wires or potential hazards coming from the holes. LPA did not observe disrepair in all facility elevators.

** Report continued on 9099-C **

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 243-4743
LICENSING EVALUATOR NAME: Michael Hood	TELEPHONE: (916) 531-7341
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2020

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 27-AS-20200724111330

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: CARLTON PLAZA OF SACRAMENTO	FACILITY NUMBER: 347002787
	VISIT DATE: 08/06/2020

NARRATIVE

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Interviews with staff indicated there were no hanging wires or potential hazards coming from the ceiling holes. Interviews with staff indicated no disrepair in facility elevators. Administrator sent LPA an invoice detailing Wi-Fi installation.

This agency has investigated the above listed allegation. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, we have found the allegation to be UNSUBSTANTIATED.

Exit interview was conducted with Administrator via telephone and a copy of this report will be provided to the facility via email. This facility shall sign and return a copy of the report to CCL and print a copy to be retained by the facility.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 243-4743
LICENSING EVALUATOR NAME: Michael Hood	TELEPHONE: (916) 531-7341
LICENSING EVALUATOR SIGNATURE:	DATE: 08/06/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2020

LIC9099 (FAS) - (06/04)

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