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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 370802857
Report Date: 02/10/2025
Date Signed: 02/10/2025 01:10:02 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
02/03/2025 and conducted by Evaluator Renita Hall
COMPLAINT CONTROL NUMBER: 08-AS-20250203085917
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:
02/10/2025
UNANNOUNCEDTIME BEGAN:
12:36 PM
MET WITH:Roger Hernandez, AdministratorTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff did not ensure clients' hygiene care needs are met
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Renita Hall conducted an unannounced visit to initiate a complaint investigation regarding the above-mentioned allegation and deliver findings. The Administrator allowed LPA entry. LPA identified herself and disclosed the purpose of the visit and elements of the complaint to the Administrator.

During today’s visit, LPA interviewed staff, obtained records, and a tour of the facility. On February 3, 2025, the Department received a complaint regarding the following allegation: Staff did not ensure clients' hygiene care needs were met.

Resident 1 (R1) was admitted to the hospital on January 5, 2025. There were no notations concerning hygiene issues at the time of admission. R1 was admitted to a Skilled Nursing Facility (SNF) on January 7, 2025, with a primary diagnosis of adult failure to thrive and schizophrenia. R1 has been a resident since April 6, 2024.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2025
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 2
Control Number 08-AS-20250203085917
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: 02/10/2025
NARRATIVE
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There was no indication of bathing concerns noted in the physician's report or facility appraisal form. Staff confirmed that R1 was prompted to take showers and complied with these prompts. R1 passed away of natural causes on January 27, 2025, at the SNF for failure to thrive. R1 did not have any family or an assigned case manager.

Based on the findings, the allegation that staff did not meet R1's hygiene care needs is unsubstantiated.
An unsubstantiated finding 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: 02/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2