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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 370802857
Report Date: 07/21/2022
Date Signed: 07/21/2022 11:18:09 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/24/2022 and conducted by Evaluator Carmen Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20220224095806
FACILITY NAME:CARROLL'S COMMUNITY CAREFACILITY NUMBER:
370802857
ADMINISTRATOR:ROGELIO HERNANDEZFACILITY TYPE:
735
ADDRESS:523 EMERALD AVENUETELEPHONE:
(619) 442-8893
CITY:EL CAJONSTATE: CAZIP CODE:
92020
CAPACITY:70CENSUS: 68DATE:
07/21/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Rogelio Hernandez, AdministratorTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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- Facility bathroom(s) is in disrepair.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegation. LPA identified herself and was granted entry by Rogelio Hernandez, Administrator. LPA stated the purpose of the visit and reviewed the findings of the complaint with Rogelio Hernandez, Administrator.

The Department’s investigation consisted of outside source and staff interviews, LPA observations and records review of relevant documents. On February 24, 2022, it was alleged that the facility bathrooms were in disrepair resulting in clients not being able to use some of the bathrooms.

Interviews with outside sources revealed that the bathrooms were in disrepair, specifically bathrooms not having shower heads and toilets not having handles to flush the toilet. Staff interviews revealed that requests have been made to have the bathrooms repaired but have yet to be repaired.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rebecca Hedgecock
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 08-AS-20220224095806
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: CARROLL'S COMMUNITY CARE
FACILITY NUMBER: 370802857
VISIT DATE: 07/21/2022
NARRATIVE
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In review of facility records, the maintenance logs for the facility revealed that requests have been made since November 2021 for bathroom in need of shower heads, broken handles on toilets, electricity needed in bathroom (lights were disconnected due to plumbing issues), and water damage on the ceiling. On March 1, 2022, LPA observed and photographed six (6) out of 12 bathrooms. The bathrooms were in need of ceilings being repaired, holes on the bathroom walls, shower heads missing, no handles on toilets to flush, and water tank covers missing. Observations during a subsequent inspection conducted on July 21, 2022 noted that some items had been repaired in facility bathrooms, specifically in the main building. The bathrooms were remodeled, and repairs have been done. LPA did observe that there are currently minor repairs such as shower heads missing, handles to showers missing, hole in one bathroom, and toilet bowel cover missing.

Based on the Department’s investigation of the above-mentioned allegation there is sufficient evidence to meet the preponderance of evidence standard. Therefore, the above allegation is deemed to be substantiated. Deficiency is noted under California Code of Regulations, Title 22, Division 6, Chapter 8, and is being cited on the attached LIC9099D form.

The report was discussed, plan of correction was jointly developed, and an exit interview was conducted with Administrator Rogelio Hernandez. A copy of this report along with Licensee/Appeal Rights (LIC9058 01/16) was provided to Administrator Hernandez at the conclusion of the visit.
SUPERVISORS NAME: Rebecca Hedgecock
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20220224095806
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: CARROLL'S COMMUNITY CARE
FACILITY NUMBER: 370802857
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/04/2022
Section Cited
CCR
80087(a)
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87465 Buildings and Grounds (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors… this requirement was not met as evidenced by:
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Administrator will contact their maintenance worker and have repairs fixed by POC due date, 8/04/22. Photos will be submitted to LPA to confirm the repairs were done.
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Based on interviews, records review and observation, licensee did not maintain bathrooms in good repair. This posed a potential health risk to 68 of 70 clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Rebecca Hedgecock
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3