370804865-6-3-2024-08-AS-IESA-D6Q2QG-20240629173552

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 370804865
Report Date: 06/03/2024
Date Signed: 06/03/2024 02:54:06 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
08/06/2021 and conducted by Evaluator Becky Kennedy

COMPLAINT CONTROL NUMBER: 08-AS-20210806165735

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:	06/03/2024
		UNANNOUNCED	TIME BEGAN:	02:07 PM
MET WITH:			TIME COMPLETED:	02:08 PM

ALLEGATION(S):

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Staff did not meet resident's hygiene needs
Staff did not report resident change of condition as required

INVESTIGATION FINDINGS:

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Licensing Program Analyst Becky Kennedy concluded the investigation which began on 8/13/21.
It was alleged that the facility staff did not meet resident's hygiene needs.

The investigation included a tour of the facility, observation of residents, interviews, and a review of documents.

The investigation revealed that Resident 1 (R1) was weak and had a loss of appetite. After a physician examined R1, they requested that facility staff send R1 to the hospital. R1 was subsequently admitted to the hospital.

It was alleged that when R1 arrived at the hospital, R1 appeared to not have adequate hygiene. R1 was described as disheveled, dirty, and had old skin clumps and old stool on their stomach and back, sores on the upper body suggesting that this was due to a lack of adequate hygiene.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Icela Estrada	TELEPHONE: (619) 688-6866
LICENSING EVALUATOR NAME: Becky Kennedy	TELEPHONE: 619-672-5843
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2024

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-20210806165735

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: 06/03/2024

NARRATIVE

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Interviews and documents revealed that R1 had the capacity to bathe, dress and groom themselves, and care for their own toileting needs. R1 did require prompts to complete hygiene tasks. It was also determined that R1 was being treated for diarrhea. It is unclear if the reported condition that R1 arrived at the hospital in was R1’s condition when they left the facility. No additional information was revealed during the investigation to confirm the allegation.

It was further alleged that facility staff did not report resident change of condition as required. The specific allegation is that facility staff noticed that R1 was becoming weak and had a decreased appetite for two weeks prior to sending R1 to the hospital.

The investigation revealed that R1 comes to every meal at the facility. R1 likes the food at the facility. Should R1 not come to a meal, facility staff would have noticed and would go look for R1 and assess their well-being. If the physician would be at the facility that day or the next, R1 would be seen by the physician at the facility. If it would be longer that the next day, or the symptoms were severe, R1 would be sent to the hospital for evaluation. R1 was seen by a physician who determined that R1 should be sent to the hospital. Facility staff arranged for R1 to be transported to the hospital.

Although R1 was weak and had a loss of appetite, no evidence was revealed to determine that the facility did not respond to R1’s change of status. This allegation is unsubstantiated.

Based on the evidence obtained during the complaint investigation,both allegations are UNSUBSTANTIATED, meaning there is not a preponderance of the evidence to determine that the alleged violations occurred.

This report, along with Licensee Rights were mailed to the licensee via USPS mail to the last known address on file.

SUPERVISOR'S NAME: Icela Estrada	TELEPHONE: (619) 688-6866
LICENSING EVALUATOR NAME: Becky Kennedy	TELEPHONE: 619-672-5843
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2024

LIC9099 (FAS) - (06/04)

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