370802857-1-19-2024-08-AS-DPOL-CZXTR6-20240129135702

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 370802857
Report Date: 01/19/2024
Date Signed: 01/19/2024 11:42:29 AM

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
01/16/2024 and conducted by Evaluator Renita Hall

COMPLAINT CONTROL NUMBER: 08-AS-20240116145202

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: 68	DATE:	01/19/2024
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Roger Hernandez, Director		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Staff are not ensuring that facility bathroom is sanitary.
Staff do not ensure that resident is administered their medication according to physician's instructions.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Renita Hall, conducted an unannounced visit to open a complaint and deliver findings regarding the above-mentioned allegation LPA was allowed entry by Roger Hernandez, Director. LPA identified herself and disclosed the purpose of the visit and elements of the findings to the Director.

On January 16, 2024, a complaint was received alleging that facility staff are not ensuring that the facility bathroom is sanitary and staff do not ensure that resident is administered their medication according to the physician's instructions. The purpose of this investigation was to determine the veracity of the allegations and take appropriate action if necessary.

LPA visit consisted of a tour of the facility bathrooms. The housekeeping staff was observed, ensuring that bedrooms and bathrooms were cleaned. Medication records were reviewed.
Continued on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Renita Hall	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 01/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2024

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-20240116145202

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: 01/19/2024

NARRATIVE

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The complainant stated an outside source had visited that facility on two different occasions and noticed the bathroom had biohazard on the toilet both times. The residents interviewed stated that bathrooms were cleaned daily by staff. The Director stated that there are three housekeeping staff in the morning, two in the evening, and two on the midnight shift with regular checks every 30 minutes except for breaks and lunch periods.

Medication Administration Logs: The logs were reviewed for the relevant resident there were no discrepancies or irregularities noted in the administration of the resident's medication.

Based on the investigation findings, it is determined that the staff are not ensuring that the facility bathroom is sanitary and staff do not ensure that resident is administered their medication according to the physician's instructions are un-substantiated. An unsubstantiated finding means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

An exit interview was conducted with Roger Hernandez, Director. A copy of this report and Licensee's Rights (LIC 9058 03/22) were provided to the Director and his signature on this report confirms receipt of the Licensee Rights.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Renita Hall	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 01/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2024

LIC9099 (FAS) - (06/04)

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