370802857-5-26-2023-08-AS-DPOL-CSBUS6-20230530154950

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 370802857
Report Date: 05/26/2023
Date Signed: 05/26/2023 06:29:59 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
12/16/2022 and conducted by Evaluator Esther Miller

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20221216091701

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: 66	DATE:	05/26/2023
		UNANNOUNCED	TIME BEGAN:	03:37 PM
MET WITH:	Anita Hernandez, Housekeeper		TIME COMPLETED:	04:50 PM

ALLEGATION(S):

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Facility did not control an infestation of pests.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Esther Miller conducted an unannounced complaint investigation visit to the facility in order to deliver findings on the above allegation. LPA was granted entry to the facility by Miriam Saboria De Escoto, Cook, after identifying herself and explaining the reason for the visit. Dinner was about to be served and LPA was asked to speak to Anita Hernandez, Housekeeper.

On December 16, 2022, it was alleged that facility did not control an infestation of pests. Specifically, it was alleged the facility had an infestation of cockroaches. The Department’s investigation consisted of review of facility records, observations, and interviews with facility staff, residents, and outside sources.

On December 22, 2022 and on May 26, 2023, LPA conducted on-site inspections of the facility, including kitchen, dining area, bathrooms, hallways, and a resident’s room. On LPA’s first visit, LPA observed no

[Continued on LIC9099-C, Page 1 of 2]

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Esther Miller
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023

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-20221216091701

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: 05/26/2023

NARRATIVE

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[Continued from LIC9099, Page 2 of 2]

roaches. On LPA’s second visit, May 26, 2023, LPA observed very small cockroaches on the wall of the kitchen. On both visits, LPA observed a hole in the wall under the sink in the kitchen. The hole had a pipe through it. Interviews with staff and outside sources confirmed that there was an active roach infestation at the facility during this time. Facility reports indicated that the roach infestation had been an ongoing physical plant issue since at least 2020, despite facility pest control efforts.

Facility records and outside source interviews indicated that facility had a pest company service spray and treated the kitchen for pests around the middle of each month for at least the past three (3) years. Pest company’s service reports and outside source interviews revealed that the facility had not followed through on the pest company’s recommendations. Specifically, facility records indicated that a hole under the triple sink in the kitchen has been recommended to be sealed up since at least 2020. Outside source interviews confirmed that the hole was not sealed up as recently as April 2023. LPA observed on May 26, 2023 that the hole under the sink was not sealed. Staff stated that the hole under the sink was constantly covered and uncovered for when the pipes were being unclogged. Administrator was not available for a full interview on May 26, 2023 during LPA’s visit due to being out of the facility. But Administrator did state that they would get the hole repaired the next week. Administrator also stated that they were going to speak to their pest company to use stronger chemicals.

Based on the evidence obtained during the complaint investigation, the allegation that facility did not control an infestation of pests is found to be SUBSTANTIATED, as there is a preponderance of evidence to show that the violation occurred. Pursuant to the California Code of Regulations, Title 22, Division 6, deficiency is being cited on the attached LIC9099D and a plan of correction was jointly developed with Housekeeper. An exit interview was conducted; a copy of this report and Licensee's Rights (LIC9058) were provided.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Esther Miller
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20221216091701

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: 05/26/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/16/2023 Section Cited CCR 80076(a)(17)	1 2 3 4 5 6 7	FOOD SERVICES: (a) In facilities providing meals to clients...: (17) All kitchen, food preparation, and storage areas shall be kept clean, free of ... rubbish, and measures shall be taken to keep all such areas free of... vermin. This requirement is not met as evidence by:	1 2 3 4 5 6 7	On the phone, Administrator agreed to have hole sealed up and a picture of the repair sent to LPA by POC date.
	8 9 10 11 12 13 14	Based on observations, interviews, and record reviews, the licensee did not control an infestation of pests for 66 of 66 residents which posed a potential health risk to residents 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: Esther Miller
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2023

LIC9099 (FAS) - (06/04)

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