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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 370802857
Report Date: 01/24/2025
Date Signed: 01/24/2025 04:05:27 PM

Substantiated


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
01/22/2025 and conducted by Evaluator Iby Strong
COMPLAINT CONTROL NUMBER: 08-AS-20250122084738
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:
01/24/2025
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Roger Hernandez, AdministratorTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Licensee did not treat for mold.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Iby Strong and Hanna Rodgers conducted an unannounced complaint visit to initiate a complaint for the above-mentioned allegation. LPAs met with Administrator Rogelio Hernandez and discussed the purpose of the visit.

On January 22, 2025, Community Care Licensing (CCL) received a complaint alleging facility has untreated mold. During investigation, LPAs collected pertinent client records as well as facility documentation and photographs, conducted a facility inspection and conducted interviews. According to the allegation, in December of 2024, Client 1 (C1) s restroom wall within the two-story building (Room 6) had large amounts of untreated mold. LPA collected pictures that were taken in December of 2024 which showed water stains on wall and ceiling, with dark areas of mold, missing pieces of ceiling and rotten wood. Interview with multiple clients present, revealed this bathroom has been in such condition for a few months. LPAs inspected the bathroom on today’s date and observed the same water damage, mold and rotten wood as observed in the previously mentioned pictures.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2025
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 4
Control Number 08-AS-20250122084738
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: 01/24/2025
NARRATIVE
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Based on interview with Administrator, the bathroom has been closed-off to prevent its use and expected to be fixed in the near future. According to the Centers for Disease Control, indoor mold has been proven to cause upper respiratory infections (www.cdc.gov). Therefore, the present mold is a health and safety concern for the clients in care.

Based on interviews, photographs, and inspection, a preponderance of evidence exists to support the allegations. Deficiencies are being cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D). An exit interview was conducted with Administrator Rogelio Hernandez, to whom a copy of this report, LIC 9099-C, LIC 9099-D, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided to.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 08-AS-20250122084738
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/24/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/21/2025
Section Cited
CCR
80087(a)
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80087 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.
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Adminsitrator states they will treat for mold and make restroom useable by POC date.
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This requirement was not met as evidence in; Based on observations and interviews the licensee did not treat for mold in 5 of 68 persons in care which posed a potential Health and Safety risk to persons 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: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
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
01/22/2025 and conducted by Evaluator Iby Strong
COMPLAINT CONTROL NUMBER: 08-AS-20250122084738

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:
01/24/2025
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Roger Hernandez, AdministratorTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Licensee did not safeguard client personal belongings
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Iby Strong and Hanna Rodgers conducted an unannounced complaint visit to initiate a complaint for the above-mentioned allegation. LPAs met with Administrator Rogelio Hernandez and discussed the purpose of the visit.- On January 22, 2025, Community Care Licensing (CCL) received a complaint alleging licensee did not safeguard client’s personal belonging. During investigation, LPAs collected pertinent client records as well as facility documentation and conducted interviews. According to allegation, in December of 2024, Client 1 (C1) had a guitar, computer and other belonging stolen from their room. Interview with Clients present revealed that they observed C1’s guitar in the trash can and believed C1 had throw it away. C1’s property inventory was unsigned and blank. Interview with staff present revealed no information to corroborate C1’s items were stolen. Interview with outside source did not reveal any pertinent information.-Based on multiple interviews and record reviews there is not a preponderance of evidence to prove alleged violations occurred, therefore the allegation is unsubstantiated. An exit interview was conducted with Administrator Rogelio Hernandez to whom a copy of this report, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 4