370804865-9-26-2023-08-AS-SJAB-CW4MW6-20230928095750

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 370804865
Report Date: 09/26/2023
Date Signed: 09/26/2023 04:35:14 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
07/27/2020 and conducted by Evaluator Ramon Serrano

COMPLAINT CONTROL NUMBER: 08-AS-20200727142134

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:	DATE:	09/26/2023
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Report Mailed to former licensee via USPS Certified Mail		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility staff do not afford residents privacy
Facility staff verbally abuse residents
Facility staff are not meeting residents' needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ramon Serrano sent this report to the former licensee at their last known mailing address via USPS certified mail and via email to deliver the investigation findings for the above allegation. The facility ceased operations on or about July 19, 2023.

Community Care Licensing (CCL) has investigated the above allegations. The investigation consisted of records review, interviews with facility staff and clients.

It was reported to CCL that Facility Staff 1 (S1) and Facility Staff 2 (S2) did not afford Resident 1 (R1) (an LIC 811 Confidential Names List was provided to the facility representative to identify the residents) privacy. It was also alleged that S1 and S2 verbally abused residents and did not meet residents call light needs. Interview with Resident 2 (R2) revealed that R2 has lived at the facility for nine years and has never experienced staff walking into R2's room unannounced. R2 stated that "staff always knocked before entering my room." R2 stated that she has never been verbally abused or yelled at by staff.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Ramon Serrano	TELEPHONE: (619) 458-2583
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

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-20200727142134

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: CARROLLS RESIDENTIAL CARE	FACILITY NUMBER: 370804865
	VISIT DATE: 09/26/2023

NARRATIVE

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R2 went on to explain that if there is a fight between residents or some sort of major incident then staff will yell to get the resident's attention. R2 stated that whenever R2 presses their call light a staff member arrives "pretty fast, usually in a couple of minutes. R2 stated that S1 is "very nice." R2 explained that R2 rarely has any contact with S1 unless R2 has a problem.

Interview with Resident 3 (R3) revealed R3 has lived at the facility for over three years. R3 stated that staff call out R3's name and knock prior to entering their room. R3 stated that R3 has never witnessed staff yelling or screaming at other residents. R3 stated that R3 is familiar with S1 and has never had any issues with S1. R3 stated that although R3 never uses their call light R3 has seen other residents use the call lights and the staff answer "pretty quick."

LPA was unable to locate R1 or R1's relative to conduct an interview.

Interview with Staff 3 (S3) revealed she has worked at the facility for 8 years and has worked with S1 and S2. S3 stated that S1 is "really helpful" and is the staff member that trained her. S3 further stated that when residents scream or over react S1 calms them down but does not scream. The only time S1 may speak loudly is if a resident is hard of hearing. S3 stated that all employees are trained to "announce self" prior to entering a residents room. S3 stated that S1 is the staff member that conducts the trainings on resident's personal rights. S3 stated that any and all staff members in the facility can answer the call lights which means that the call lights are usually answered within a few minutes. S3 stated that S2 no longer works at the facility but that she never witnessed or heard of S2 ever screaming or yelling at residents in care.

Interview with S1 revealed she has worked at the facility for 16 years. In regards to entering a resident's room, the protocol is to knock and announce yourself and then enter or use master key to enter. S1 stated that all residents have a key to their room. Call lights are usually answered in 3-4 minutes. S1 stated that the panel will beep constantly until a staff member goes into the room to reset the call light. S1 stated that R1 was at the facility for less then a year. R1 was very independent. R1 went to the hospital one day and then was admitted to a Skilled Nursing Facility and never returned since it was determined that R1 needed a higher level of care. S1 stated that their are many residents that have hearing problems so staff do need to occasionally speak loudly. S1 stated that although S2 no longer works at the facility, she never received a complaint regarding S2. S1 stated that S2 spent a lot of time with residents and was very pleasant.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Ramon Serrano	TELEPHONE: (619) 458-2583
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20200727142134

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: CARROLLS RESIDENTIAL CARE	FACILITY NUMBER: 370804865
	VISIT DATE: 09/26/2023

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	Based upon the foregoing, the above listed allegations are unsubstantiated. This finding means that the preponderance of the evidence standard has not been met and the allegations are not valid. A copy of this report along with Licensee/Appeal Rights (LIC 9058) was mailed via USPS Certified Mail to the former licensee’s mailing address on file.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Ramon Serrano	TELEPHONE: (619) 458-2583
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023

LIC9099 (FAS) - (06/04)

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