370802857-8-29-2025-08-AS-SMAZ-DMXSMW-20251030140038

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 370802857
Report Date: 08/29/2025
Date Signed: 08/29/2025 11:43:29 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
01/07/2025 and conducted by Evaluator Renita Hall

COMPLAINT CONTROL NUMBER: 08-AS-20250107121127

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:	08/29/2025
		UNANNOUNCED	TIME BEGAN:	11:37 AM
MET WITH:	Roger Hernandez, Administrator		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Facility staff did not ensure resident received medications as prescribed
Facility staff did not answer communications from resident's family

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Renita Hall conducted an unannounced visit to deliver findings. LPA was allowed entry by the Administrator. LPA identified herself and disclosed the purpose of the visit and elements of the findings to the Administrator.

On January 7, 2025, the Department received a complaint for the following allegations: Facility staff did not ensure the resident received medications as prescribed, and Facility staff did not answer communications from the resident's family. The investigation included a facility tour, records review, interviews with staff, and outside sources.

Reviewed medication administration records and found all entries were correct and signed by staff. Medication records for the facility will document if residents decline/refuse medications. Interviewed staff responsible for medication distribution; they reported no errors or discrepancies during recent administration cycles.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sabel Martinez
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2025

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-20250107121127

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: 08/29/2025

NARRATIVE

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The clients interviewed did not report any issues or adverse effects related to medication. The Conservator clarified that there was a misunderstanding regarding the medication error. The therapist at the hospital explained that the resident did not take a double dosage of medication. The resident was seen by the Psychiatrist, who provided a new prescription. The resident was currently under observation to assess the effectiveness of the medication before discharge.

Staff interviewed confirmed that the phone is monitored continuously during business hours, with a protocol in place for handling after-hours calls. A test call during the investigation was answered promptly by the facility. The Conservator stated that the last contact with the facility was on December 31, 2024, and confirmed that they are always able to leave a message at the facility. Additionally, the Conservator shared that they are working on relocating the resident to a new facility.

The investigation found no evidence to support the allegations of a medication error or failure to answer the phone. Both complaints are unsubstantiated based on documentation, staff interviews, and protocol review.
A finding that is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violation occurred.

An exit interview was conducted with the 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: Sabel Martinez
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2025

LIC9099 (FAS) - (06/04)

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