370802857-3-12-2025-08-AS-APAO-DKW6S9-20250825210335

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 370802857
Report Date: 03/12/2025
Date Signed: 03/12/2025 12:04:13 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
03/05/2025 and conducted by Evaluator Renita Hall

COMPLAINT CONTROL NUMBER: 08-AS-20250305102618

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:	03/12/2025
		UNANNOUNCED	TIME BEGAN:	11:05 AM
MET WITH:	Roger Hernandez, Administrator		TIME COMPLETED:	12:05 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Lack of supervision resulted in resident being assaulted

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Renita Hall conducted an unannounced visit to initiate a complaint investigation and delivered findings regarding the above-mentioned allegation. 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 toured the facility. On March 5, 2025, the Department received a complaint regarding the following allegation: A lack of supervision resulted in the resident being assaulted.

LPA contacted the reporting party, who is a mandated reporter, and stated that their office policy is to report all abuse for staff assaulting residents or resident assaulting other residents. The reporting party did not have any concerns about the facility's lack of supervision.

Continued on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025

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-20250305102618

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: 03/12/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Resident 1 (R1) was the aggressor who assaulted another resident. An outside source was called to assist the facility in redirecting R1. R1's primary diagnosis is schizoaffective disorder. The Administrator stated that two occurrences on 02/22/25 and 03/04/25 that required the involvement of non-emergency services for R1. The resident was experiencing significant mental health difficulties, displaying behaviors not consistent with their typical mental functioning. Despite this resident demonstrating complete compliance with all medical prescriptions and showing no need for regular prompting, the severity of their symptoms required professional intervention. The unexpected onset of the crisis was out of character, considering the resident's general disposition and self-sufficiency. At present, the resident is under the care of the hospital's behavioral health department, ensuring they receive the necessary mental health support.

Based on the evidence in the investigation, the allegation of a Lack of supervision resulted in the resident being assaulted was deemed unsubstantiated based on the findings. 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: 03/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 2