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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 03:17:37 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
04/17/2020 and conducted by Evaluator Sabel Martinez
COMPLAINT CONTROL NUMBER: 08-AS-20200417135157
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 OrtegaTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff did not maintain facility free of clutter
Staff did not secure hazardous items
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Sabel Martinez, conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegations. The LPA was greeted by Activities Director, Erika Mireles, identified himself, and disclosed the purpose of the visit. Med Tech, Stephanie Ortega, arrived during the visit and assisted the LPA.

The Department’s investigation consisted of review of records, and interviews with internal and external sources.

It was alleged the staff did not maintain the facility free of clutter. An internal source reported the facility was storing large trash, including mattresses, a toilet, buckets, and other plastic containers within the facility grounds. Interviews with additional internal sources revealed staff had kept broken mattresses and other large waste items. These items were not immediately discarded as they did not fit in the weekly trash collection bin.
Substantiated
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 5
Control Number 08-AS-20200417135157
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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After a significant amount of trash was gathered, the facility staff secured a large enough vehicle, or a waste container to transport the items to the local waste management facility. Observations by one LPA corroborated the staff had kept multiple mattresses, buckets, and other waste on premises.

It was alleged staff did not secure hazardous items. An internal source reported the facility had toxic materials within the facility grounds. Interviews with internal sources revealed the facility had an area where discarded items were held. This area was considered to be off limits to the residents in care. Observations by LPAs confirmed this area had paint buckets with paint residue, aluminum bucket lids, gardening tools, and no physical barrier preventing the residents from having access to these items.

Based on evidence obtained, the allegations are substantiated which means that the allegations are valid because the preponderance of the evidence standard has been met. The deficiencies were cited in accordance with California Code of Regulations, Title 22, and listed on the LIC 9099D. A plan of correction was jointly formulated with Med Tech, Stephanie Ortega.

An exit interview was conducted with Med Tech, Stephanie Ortega, to whom a copy of this report, LIC 9099D 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 5
Control Number 08-AS-20200417135157
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: 12/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/15/2022
Section Cited
CCR
80087(a)
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80087 Buildings and Grounds (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement was not met as evidence by:
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Administrator agreed to remove all the clutter in question by 01/11/2023. Administrator will submit proof of this by 1/11/2023.
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Based on interviews and observations, the licensee did not ensure the facility was clean, and safe, which posed a potential health, safety, and personal rights risk to 67 of 67 residents in care.
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Type B
12/15/2022
Section Cited
CCR
80087(b)
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80087 Building and Grounds (b) All clients shall be protected against hazards within the facility through provision of the following: This requirement was not met as evidence by:
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Adminstrator agreed to remove hazardous items by 01/11/2023. Administrator will submit proff of this by 1/11/2023.
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Based on observations, and interviews, the Licensee did ensure the residents were protected against hazards within he facility, which posed a potential health, safety and personal rights risk to 67 of 67 residents in care.
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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: Sabel Martinez
LICENSING EVALUATOR SIGNATURE:

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

DATE: 12/15/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
04/17/2020 and conducted by Evaluator Sabel Martinez
COMPLAINT CONTROL NUMBER: 08-AS-20200417135157

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 OrtegaTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Unlawful Eviction
Unqualified staff administered medication
Facility is not providing a safe environment
Resident was not treated with dignity
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Sabel Martinez, conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegations. The LPA was greeted by Activities Director, Erika Mireles, identified himself, and disclosed the purpose of the visit. Med Tech, Stephanie Ortega, arrived during the visit and assisted the LPA.

The Department’s investigation consisted of review of records, and interviews with internal and external sources.

It was alleged the facility unlawfully evicted a resident. An interview with an internal source revealed the resident believed the resident would be evicted after law enforcement removed the resident from the room and an eviction notice was found on the resident’s door. There had been an incident were the resident in question had placed hands on another resident, resulting in law enforcement intervening and the resident being hospitalized. (See LIC 9099C)
Unsubstantiated
Estimated Days of Completion:
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: 4 of 5
Control Number 08-AS-20200417135157
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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To the resident's knowledge, the eviction had been rescinded after it was addressed with management. An interview with an additional internal source corroborated the facility had work with the resident, the eviction was rescinded, but the resident was warned the behavior could lead to an eviction. Records obtained at the facility corroborated house rules stated physical abuse toward other residents, or staff could potentially lead to the facility requesting the resident vacate the facility.

It was alleged the facility had an unqualified staff assisting with medication at the facility. Interviews with internal sources consistently stated the facility staff assisting with medication were knowledgeable and knew what they were doing. An interview with an external source corroborated the staff in question was trained, and the staff would often have assistance from other trained staff at the facility. Records reviewed corroborated the staff in question had undergone training on how to assist residents with medication.

It was alleged the facility did not provide a safe environment. An internal source reported outside individuals would often enter the facility grounds and staff would not do anything about it. Interviews with internal sources consistently reported the facility staff would ask the unknown individuals to leave the facility. When the unknown individuals declined to leave the property, staff did call law enforcement for assistance. The facility build a fence and posted signs to deter outside individuals from entering the facility. Records obtained from an outside source did not reveal any concerns with staff not addressing this concern.

It was alleged staff did not treat residents with dignity. An internal source reported the facility staff would call residents inappropriate names. Interviews with internal sources revealed conflicting statements. Some statements indicated the facility staff had not been witnessed to call resident names, and that staff often had to deal with the residents calling staff names. Other internal statements stated staff was heard calling residents names, but were not able to disclose, or refused to disclose which staff, resident, nor what was heard. Interviews with external sources did not reveal any concerns regarding staff not treating the residents with dignity.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove


the alleged violation(s) did, or did not occur, therefore, the allegations are unsubstantiated.

An exit interview was conducted with Med Tech, Stephanie Ortega, to whom a copy of this report and Licensee's 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: 5 of 5