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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 370802857
Report Date: 03/12/2025
Date Signed: 03/12/2025 12:33:50 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-20250305151608
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:
03/12/2025
UNANNOUNCEDTIME BEGAN:
12:06 PM
MET WITH:Roger Hernandez, AdministratorTIME COMPLETED:
12:33 PM
ALLEGATION(S):
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Staff mishandled a client's medication
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Renita Hall conducted an unannounced visit to initiate a complaint investigation and deliver 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: Staff mishandled a client's medication.

LPA received documentation from the reporting party from the pharmacy that indicated medication for suboxone 8mg-2mg sublingual film C-III 30 film with one refill left, start date January 16, 2025, stop date March 16, 2025, last written on January 16, 2025.

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-20250305151608
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
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The reporting party stated that R1 had a refill of the medication on February 14, 2025. A review of medication showed a refill for February 14, 2025, with nine(9) films left in the box and zero refills. Medication is for 30 days at a time. R1 needs multiple prompting for compliance in medication. On March 5, 2025, R1 called emergency services and was taken to the hospital and was hospitalized until March 10, 2025, and returned to the facility on March 10, 2025. R1 called emergency services again on March 10, 2025, and has not been discharged from the hospital's behavioral services. There are no discrepancies in the number of films left in the medication box of nine (9) from February 14, 2025, to March 5, 2025. R1's primary diagnosis is bipolar disorder, secondary ADHD.

Based on the evidence in the investigation, the allegation of staff mishandled a client's medication 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