370802857-6-12-2024-08-AS-LTEZ-DG9AA8-20250501000243

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 370802857
Report Date: 06/12/2024
Date Signed: 06/12/2024 12:12:32 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
06/05/2024 and conducted by Evaluator Renita Hall

COMPLAINT CONTROL NUMBER: 08-AS-20240605132454

FACILITY NAME:	CARROLL'S COMMUNITY CARE		FACILITY NUMBER:	370802857
ADMINISTRATOR:	ROGELIO HERNANDEZ		FACILITY TYPE:	735
ADDRESS:	523 EMERALD AVENUE		TELEPHONE:	(619) 442-8893
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92020
CAPACITY:	70	CENSUS: 66	DATE:	06/12/2024
		UNANNOUNCED	TIME BEGAN:	10:16 AM
MET WITH:	Roger Hernandez, Administrator		TIME COMPLETED:	11:40 AM

ALLEGATION(S):

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Physical abuse of client by faclity staff

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Renita Hall, conducted an unannounced visit to initiate a complaint investigation and delivered findings regarding the above-mentioned allegation. 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 5, 2024, an allegation was made against the Carroll's Community Care staff. The specific allegation was Physical abuse of client by facility staff. On June 12, 2024, LPA interviewed residents, staff members, and outside sources who may have witnessed or had relevant information regarding the incident. LPA reviewed relevant documentation, including resident care plans, incident reports, and any other relevant records.

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)

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Control Number 08-AS-20240605132454

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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The outside source, residents, and staff had not witnessed or had been informed that there was any physical abuse towards residents. Resident 1 (R1) primary diagnosis is schizophrenia and denied that there was any physical abuse towards them.

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)

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