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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 370802857
Report Date: 06/12/2024
Date Signed: 06/12/2024 12:08:10 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
06/10/2024 and conducted by Evaluator Renita Hall
COMPLAINT CONTROL NUMBER: 08-AS-20240610102333
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: 66DATE:
06/12/2024
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Roger Hernandez, AdministratorTIME COMPLETED:
12:20 PM
ALLEGATION(S):
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Staff did not ensure resident's bathroom ceiling was not in disrepair
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Renita Hall, conducted an unannounced visit regarding the above-mentioned allegation to open and deliver findings. LPA was allowed entry by Roger Hernandez, Administrator. LPA identified herself and disclosed the purpose of the visit and elements of the complaint to the Administrator.

On June 10, 2024, the Department received a complaint that Staff did not ensure the resident's bathroom ceiling was not in disrepair. On June 12, 2024, LPA interviewed staff and conducted a tour of the facility rooms and bathrooms remodeling had begun on part of the second floor of the two-story building. The bathroom in question resident was bathing at the time of the tour. The bathroom is located on the first floor. The facility maintenance staff has begun work on the bathroom and is unable to complete it until the drywall is completely dry. The upstairs bathroom was flooded by residents which caused the damage. The bathroom that caused the damage has been closed for repairs. The residents can use other bathrooms located throughout the facility.

Continued on 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
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 2
Control Number 08-AS-20240610102333
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: CARROLL'S COMMUNITY CARE
FACILITY NUMBER: 370802857
VISIT DATE: 06/12/2024
NARRATIVE
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Based on the investigation findings, the allegation made against the facility is unsubstantiated. A finding that is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

An exit interview was conducted with Roger Hernandez, Administrator. A copy of this report and Licensee's Rights (LIC 9058 03/22) were provided to the Administrator and his signature on this report confirms receipt of the Licensee Rights
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2