370804865-8-22-2023-08-AS-SJAB-CV6P4Q-20230829105930

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 370804865
Report Date: 08/21/2023
Date Signed: 08/22/2023 07:40:35 AM

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
07/15/2020 and conducted by Evaluator Debbie Correia

COMPLAINT CONTROL NUMBER: 08-AS-20200715142159

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:	0	CENSUS: 0	DATE:	08/21/2023
		UNANNOUNCED	TIME BEGAN:	01:38 PM
MET WITH:	Administrator Bryan Meyers		TIME COMPLETED:	03:40 PM

ALLEGATION(S):

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Facility is in disrepair.
Facility menus are not approved by a qualified individual.
Facility has bed bugs.
Facility staff did not safeguard residents' personal belongings.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced visit regarding the above listed allegations. LPA identified herself to Administrator Bryan Meyers, was granted entry, and explained the purpose of the visit.

The Department’s investigation consisted of staff, resident, and outside source interviews, a facility tour, and a facility and outside source records review.

It was alleged that the facility was in disrepair. Specifically, there were inoperable air conditioner units in some of the resident’s rooms. At the time of the follow up visit there were no issues with AC units, and no corroborating evidence regarding the allegation.

It was also alleged that facility menus were not approved by a qualified individual. A facility records review and and an outside source interview revealed the facility had a hired dietician consultant who owned a private practice specializing in personal nutrition. An interview with an outside source also revealed the consultant worked one-on-one with the residents and kitchen staff to ensure the resident’s nutritional needs and diets were met. A facility records review also revealed pre-planned menus with sufficient meals provided to the residents in care.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie Correia	TELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2023

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-20200715142159

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: 08/21/2023

NARRATIVE

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Additionally, it was alleged that the facility had bed bugs. A facility records review and outside source interview revealed that the facility had a contract with a pest control agency that last serviced the facility on June 19, 2020 and came routinely every 4 weeks for pest control, including bed bugs.

Lastly, it was alleged the facility staff did not safeguard residents' personal belongings. An interview with Resident 1 (R1) revealed they were missing money that was taken from their personal belongings. A facility record review revealed documentation that requires signature of acknowledgement by the resident at the time of admission, that defined the facility is not responsible for any money, valuables, or other personal property brought into the facility unless given to the Licensee for safeguarding.

Based on interviews, LPA observations, and records review, a preponderance of evidence does not exist to prove that the alleged violation(s) occurred, therefore the allegations are unsubstantiated. An exit interview was conducted with Administrator Meyers to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided, and signature on this form acknowledges receipts of the reports.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie Correia	TELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2023

LIC9099 (FAS) - (06/04)

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