370804865-2-28-2022-08-AS-IESA-CC439S-20220228170338

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 370804865
Report Date: 02/25/2022
Date Signed: 02/28/2022 08:53:43 AM

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
08/03/2021 and conducted by Evaluator Anna Kennedy

COMPLAINT CONTROL NUMBER: 08-AS-20210803083230

FACILITY NAME:	CARROLLS RESIDENTIAL CARE		FACILITY NUMBER:	370804865
ADMINISTRATOR:	BRYAN MEYERS		FACILITY TYPE:	740
ADDRESS:	655 S MOLLISON		TELEPHONE:	(619) 444-3181
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92020
CAPACITY:	144	CENSUS: 111	DATE:	02/25/2022
		UNANNOUNCED	TIME BEGAN:	03:26 PM
MET WITH:	Victor Wims		TIME COMPLETED:	04:12 PM

ALLEGATION(S):

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Staff was unaware that resident was AWOL.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kennedy conducted an unannounced complaint visit to deliver investigative findings for the above allegation. LPA identified herself and was invited in to the facility.
LPA met with Victor Wims, Staff Member and discussed the purpose of today's visit.

During the investigation, LPA reviewed records, conducted interviews with internal and external sources and toured the facility.

The allegation is that the facility staff were unaware that resident was AWOL. Resident 1 (R1) (see LIC 811 for confidential names) left the facility to go out in the community as R1 does on an almost daily basis. R1 has sensory deficits resulting in challenges communicating.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Rebecca Hedgecock	TELEPHONE: (619)767-2329
LICENSING EVALUATOR NAME: Anna Kennedy	TELEPHONE: (619) 997- 4108
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2022

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-20210803083230

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: CARROLLS RESIDENTIAL CARE	FACILITY NUMBER: 370804865
	VISIT DATE: 02/25/2022

NARRATIVE

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While in the community, a citizen encountered R1 and became concerned for R1’s wellbeing and transported R1 to the hospital. R1 was able to inform the hospital staff where he lives, and the facility was informed of R1’s whereabouts. R1 was at the hospital overnight for an evaluation and released back to the facility the following day with no new diagnosis. R1 had not experienced a change in condition rendering R1 unsafe in the community.

Residents can freely come and go from the facility, and R1 regularly did so. R1 was taken to the hospital and the facility was informed of R1’s whereabouts prior to the time R1 would be expected to return. The facility staff had no reason for concern prior to the call informing facility staff of R1’s whereabouts.

R1 was not “AWOL” or away from the facility longer than expected without facility staff being aware. This allegation is unfounded, meaning that the allegation is false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

This report was discussed with Victor Wims, Staff Member. A copy along with Licensee Rights (01/2016) was emailed to the facility at the conclusion of the visit. An electronic response confirms the receipt of these documents.

SUPERVISOR'S NAME: Rebecca Hedgecock	TELEPHONE: (619)767-2329
LICENSING EVALUATOR NAME: Anna Kennedy	TELEPHONE: (619) 997- 4108
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2022

LIC9099 (FAS) - (06/04)

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