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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 370802857
Report Date: 12/15/2022
Date Signed: 12/15/2022 12:52:20 PM

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
10/28/2022 and conducted by Evaluator Sabel Martinez
COMPLAINT CONTROL NUMBER: 08-AS-20221028092840
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: 67DATE:
12/15/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Activities Director, Erika Mireles, and Med Tech, Stephanie Ortega TIME COMPLETED:
12:50 PM
ALLEGATION(S):
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Staff did not meet resident's hygiene needs
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Sabel Martinez, conducted an unannounced complaint investigation visit at the facility regarding the above allegation. The LPA gained access to the facility, identified himself to Activities Director, Erika Mireles, and disclosed the purpose of the visit. Med Tech, Stephanie Ortega, arrived during visit and assisted with the LPA.

Throughout the investigation the Department secured pertinent records and conducted interviews with internal and external sources.

It was alleged staff did not meet a resident’s hygiene needs. An outside source reported a resident was witnessed to be covered in lice and have and unkept appearance. Interviews with internal sources revealed the facility did have some residents who presented with lice. The facility staff addressed this by seeking treatment for the affected residents and this prevented the spread. These sources also reported the facility provided hygiene supplies to the residents, and residents had the option of buying their own supplies.
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Sabel Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022
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 2
Control Number 08-AS-20221028092840
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: 12/15/2022
NARRATIVE
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Interviews with outside sources did not reveal any concerns regarding the facility not addressing hygiene concerns, nor the facility not providing hygiene supplies to the residents. Observations by the LPA corroborated the facility had hygiene supplies available to the residents at the facility.

Based on the evidence gathered throughout the investigation, there was not a preponderance of evidence to prove the alleged violation occurred, therefore, the allegation is Unsubstantiated.

An exit interview was conducted with Med Tech, Stephanie Ortega, to whom a copy of this report, and Licensee/Appeals Rights (LIC 9058) were provided to.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Sabel Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2