370802857-2-14-2024-08-AS-AROS-D2G3MH-20240214172223

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 370802857
Report Date: 02/14/2024
Date Signed: 02/14/2024 06:46:35 PM

Document Has Been Signed on 02/14/2024 06:46 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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
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: 67	DATE:	02/14/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Administrator Roger Hernandez		TIME COMPLETED:	05:30 PM

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Licensing Program Analysts (LPA) Amy Rodgers conducted an unannounced Required Annual Inspection to ensure substantial compliance with Title 22 regulations. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Administrator Roger Hernandez.

According to the facility’s license, the facility has a maximum capacity of seventy (70), all of whom must be ambulatory. This facility does not feature a secured perimeter or delayed egress doors.

LPA, accompanied by licensee’s staff, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in adequate repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Toilets, and showers were in working order. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility’s ambient internal temperature was with regulation range. Hot water temperature at taps accessible to clients were all compliant.

Refrigerator and Freezer temperature were complaint. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present and in good repair. There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to clients. Medications were labeled, as required, and stored in locked areas.

[CONTINUED ON LIC 809-C]

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 02/14/2024

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[CONTINUED FROM LIC 809]

There is a not a pool on water feature on the premises. Per the licensee's staff, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA observed that residents were being treated with dignity by staff, and there were sufficient staff on duty to meet resident’s needs.

LPA interviewed multiple staff and clients. LPA reviewed multiple staff and client records/files. The interviews did not raise any significant licensing concerns. The reviewed files contained required documents. Confidential records were stored in locked areas. Licensee's staff also presented proof of current/active business liability insurance.

No deficiencies were observed or cited during today's annual inspection. However, Technical Violation were given.

An exit interview was conducted with, Administrator Roger Hernandez to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2024

LIC809 (FAS) - (06/04)

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