370802857-12-5-2022-08-AS-SJAB-CMLME6-20221230083211

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 370802857
Report Date: 12/05/2022
Date Signed: 12/05/2022 05:21:34 PM

Substantiated

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
11/29/2022 and conducted by Evaluator Elizabeth Hamilton

COMPLAINT CONTROL NUMBER: 08-AS-20221129130659

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:	12/05/2022
		UNANNOUNCED	TIME BEGAN:	11:05 AM
MET WITH:	Administrator, Rogelio Hernandez and Med Tech, Stephanie Ortega		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility was in disrepair

INVESTIGATION FINDINGS:

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

Licensing Program Analysts (LPAs) Elizabeth Hamilton and Dawn Segura conducted an unannounced complaint investigation at the facility for the above allegation. LPAs gained access to the facility, identified themselves and met with Administrator, Rogelio Hernandez. LPA Hamilton explained the purpose of the visit and the elements of the complaint.

The investigation consisted of client records requested and reviewed, interviewed clients, Administrator and outside sources and briefly toured the facility.

On November 29, 2022, it was alleged that since early Spring of 2022, the facility was in disrepair. It was alleged that clients’ rooms did not have screens on the windows or working electrical outlets. Interviews with outside sources revealed that clients in care were residing in rooms that had electrical outlets that were inoperable and no window screens.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Elizabeth Hamilton
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2022

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 3

Control Number 08-AS-20221129130659

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: 12/05/2022

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

During today’s visit, while touring the facility, LPAs visited a number of rooms and observed multiple client rooms with inoperable electrical outlets, which included building one, rooms; four, six, seven, eight, nine and thirteen and building two, rooms; eight, nine, thirteen, fourteen and fifteen. Room fourteen in building two, a client occupied room, had no overhead lighting, but client was provided a lamp; however, the room had no working electrical outlets. Room nine in building one, another client occupied room, had three exposed electrical outlets, one of which appeared to have burn damage. LPAs also observed multiple client room and bathroom windows without screens. LPAs observations further revealed bedroom seven, in building one to have a cracked window. Both, bedroom nine in building one and bedroom fourteen in building two, had multiple holes in the walls.

The Department has investigated the allegation of facility was in disrepair. Based on evidence obtained, the allegation is substantiated which means that the allegation is valid because the preponderance of the evidence standard has been met. A deficiency is cited in accordance of California Code of Regulations, Title 22, Division 6 Chapter 8, and listed on the 9099D.

An exit interview was conducted with Med Tech, Stephanie Ortega a copy of this report, LIC 9099D and Licensee/Appeals Rights (LIC 9058 01/16) was provided.

LPAs were away from the facility for two hours during the visit.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Elizabeth Hamilton
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 08-AS-20221129130659

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/05/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/04/2023 Section Cited CCR 80087	1 2 3 4 5 6 7	80072 Personal Rights (a)(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Administrator stated he would ensure all windows which open and are used by clients would have screens installed, would replace building one, room sevens cracked window, repair building one room nine’s and building two, room fourteen’s electrical outlets to make them operational. Building one, room nine and building two, room fourteen’s holes on walls will be patched. Administrator will further cover all non-operational electrical outlets in all other rooms by 01/04/2023.
	8 9 10 11 12 13 14	Based on interviews and LPA observations, the licensee did not ensure that the clients in care were provided safe and healthful accommodations. This posed a potential personal rights risk to 67 of 67 clients in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Elizabeth Hamilton
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 3