370804865-1-31-2024-08-AS-IESA-D226RA-20240131200202

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 370804865
Report Date: 01/31/2024
Date Signed: 01/31/2024 05:10:01 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
07/19/2022 and conducted by Evaluator Liliana Silveira

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20220719132345

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: 124	DATE:	01/31/2024
		UNANNOUNCED	TIME BEGAN:	04:30 PM
MET WITH:	Sarita Mendoza, Office Assistant		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Resident was assaulted by another resident due to lack of supervision

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Liliana Silveira conducted an unannounced complaint investigation visit. LPA Silveira introduced themselves, met with Office Assistant Sarita Mendoza and disclosed the purpose of the visit. The purpose of the visit was to deliver findings for the above-mentioned allegation.

The Department’s investigation consisted of interviews with staff, residents, law enforcement (LE) and outside sources. A records review was also completed. It was alleged that due to lack of supervision a resident (R1) was sexually assaulted by another resident (R2).

A review of a medical report dated 07/14/22 revealed that R1 is diagnosed with schizophrenia, paranoid type and has a long history of mental illness. R1 reported to the Department and to law enforcement that the sexual assault occurred on July 18, 2022. An interview with an outside source (OS1) revealed R1 reported being sexually assaulted on June 28, 2022, and on July 18, 2022, by R2 in R1’s bedroom. [CONTINUED ON LIC 9099-C]

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) 767-2311
LICENSING EVALUATOR NAME: Liliana Silveira	TELEPHONE: (619) 481-0844
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024

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-20220719132345

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: 01/31/2024

NARRATIVE

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[CONTINUED FROM LIC 9099] A review of a facility report dated 07/16/22 and an interview with the Administrator revealed that a couple of weeks prior to the allegation being made, R1 had been acting more paranoid and confrontational with residents.

During an interview with the Administrator, it was revealed that R1 had a known history of making false allegations. For instance, two days after R1 reported the sexual assault by R2 (July 18, 2022), R1 reported to the Administrator that they had been sexually assaulted in the street outside the facility; however, the Administrator observed R1 sitting in the dining room most of the day and R1 hadn’t left the facility. On another occasion, the Administrator observed R1 casually lay themselves on their bedroom floor and then push the panic button. Staff later arrived and R1 told them they had fallen and hurt themselves. An interview with facility staff (S1) also revealed that R1 hallucinates, and on multiple occasions, R1 changed the timeline and story regarding the sexual assault incident. The interview with S1 also revealed that R1 has had issues with other residents at the facility and has called police many times.

In the interview with OS1 by LE, R1 had reported to OS1 that they had been sexually assaulted twice by R2. In an interview with the Department, R1 stated that they had been sexually assaulted “only once.” During the review of a medical report dated 07/28/22, the medical professional’s notes indicated that R1 had reported to them that they had been sexually assaulted and sent to the Emergency Room (ER) with negative results. The report also indicated that R1 “now reports they were not sexually assaulted.” The medical professional also documented that R1 was delusional.

In an interview with the Department, the alleged perpetrator (R2) was not associated to time and place during the interview and was confused about why they were being interviewed. R2 stated that they did not know R1 and when asked if they had entered another person’s room uninvited, R2 stated “no, that never happened.” An interview with a law enforcement detective also revealed that they were unable to interview R2 due to R2’s mental status. R2 was not able to answer simple questions. An interview with facility staff revealed that R2 was new to the facility and on occasion would walk into the wrong room due to confusion, but that it had not caused any issues. A review of R2’s medical report dated 06/15/2022 revealed that R2 is diagnosed with Schizoaffective Disorder and Anxiety Disorder. [CONTINUED ON LIC 9099-C]

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) 767-2311
LICENSING EVALUATOR NAME: Liliana Silveira	TELEPHONE: (619) 481-0844
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20220719132345

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: 01/31/2024

NARRATIVE

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[CONTINUED FROM LIC 9099-C]
During an interview with the Department on 07/28/22, R1 stated that they were sexually assaulted by R2 “a few weeks ago” on a Saturday, but R1 was unable to provide the date for the Saturday when it occurred. R1 stated that they knew it occurred at 3:00 AM but did not know how R2 appeared in their room since they locked the door and double checked it. R1 claimed that R2 “must have gotten a key from their ex-roommate.” R1 was asked if they screamed for help when the incident occurred, and R1 stated that they did not because they “didn’t want to wake anybody.” R1 was also asked if they observed any bruises, scratches, or other injuries on their body as a result of the incident involving R2, R1 stated “no”. On 07/18/22 a Suspected Abuse Response Team (SART) examination was performed on R1. The nurse performing the examination did not find any obvious signs of injury or trauma.

Due to a lack of corroborating evidence, no witnesses and inconsistent statements provided regarding the incident, the allegation that a resident was sexually assaulted by another resident due to lack of supervision is unsubstantiated. This finding means that although the allegation may have happened or could be valid, there is not a preponderance of evidence to prove that the alleged violation occurred.

LPA Silveira conducted an exit interview with Sarita. At the time of the exit interview Sarita was provided with a copy of the Complaint Investigation Report (LIC9099) and Licensee Rights (LIC9058 01-2016). The signature on this report acknowledges receipt of the rights.

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) 767-2311
LICENSING EVALUATOR NAME: Liliana Silveira	TELEPHONE: (619) 481-0844
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024

LIC9099 (FAS) - (06/04)

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