370802857-8-30-2022-08-AS-SJAB-CHTSEY-20220831134931

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 370802857
Report Date: 08/29/2022
Date Signed: 08/30/2022 08:32:08 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
04/24/2020 and conducted by Evaluator Debbie Correia

COMPLAINT CONTROL NUMBER: 08-AS-20200424165713

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:	08/29/2022
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Administrative Assistant Patricia Mireles		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility staff withholds resident's food.
Facility staff did not destroy medication properly.
Facility staff did not administer resident's medication as prescribed.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced visit to deliver findings regarding the above-mentioned complaint allegations. LPA met with Administrator Assistant Patricia Mireles, identified herself, and stated the purpose of the visit.

The Department’s investigation consisted of outside source, staff, and client interviews, and secured pertinent records. The investigation also consisted of a facility tour.

It was alleged that staff withheld food from Resident’s (C1). C1 was admitted to the facility on February 26, 2019 with a primary diagnosis of Schizo affective Bipolar disorder. A resident record revealed C1 was highly functional and mentally stable. A facility record review, as well as staff and client interviews, revealed the facility serves 3 meals a day during 2 hour increments. Interviews with facility staff revealed they go to each client’s room who are not present during meals to ensure they are notified and aware it is mealtime.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2022

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-20200424165713

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: CARROLL'S COMMUNITY CARE	FACILITY NUMBER: 370802857
	VISIT DATE: 08/29/2022

NARRATIVE

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Staff and client interviews also revealed clients are able to come and leave the facility as they please. If clients are not present or available during mealtimes the food is maintained for two hours and then discarded. Interviews with both staff and clients also revealed snacks are always available and often kitchen staff will cook outside of mealtimes for clients as a courtesy, however there is more than sufficient time to eat. An outside source interview and staff interviews corroborated C1 was highly independent, and was often out in the community and capable of purchasing their own food using their EBT card. Staff interviews also revealed when notifying C1 it was mealtime, C1 would often be sleeping and would not get up to eat. A staff interview also reveal due to C1’s diagnosis of diabetes their sugar level was always checked when approaching kitchen staff for food, depending on C1’s sugar level C1 was always fed appropriately.

It was also alleged staff did not distribute and destroy medication properly. A resident record review C1 was able to self administer medications. Interviews with facility staff and an outside source and a facility record review revealed if a client is not present or refuses medication, the facility staff documents a medication refusal, notifies the client’s physician and discards the medication in a bio-hazard container provided by an outside agency, who will then pick up the container and properly destroy the medication.

Due to lack of corroborating evidence, the finding regarding the above allegations were established to be unsubstantiated. This finding means although the allegations may have happened or could be valid, there is not a preponderance of evidence to prove that the alleged violations occurred.

An exit interview was conducted with Administrative Assistant Patricia Mireles and a copy of this report along with Licensee/Appeal Rights (LIC 9058 01/16) was provided and signature on this form confirms receipt of these reports.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2022

LIC9099 (FAS) - (06/04)

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