374604690-8-8-2023-08-AS-DPOL-CV7TQA-20230830145538

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604690
Report Date: 08/08/2023
Date Signed: 08/08/2023 12:34:05 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
08/04/2023 and conducted by Evaluator Renita Hall

COMPLAINT CONTROL NUMBER: 08-AS-20230804134540

FACILITY NAME:	CARROLL'S RESIDENTIAL CARE		FACILITY NUMBER:	374604690
ADMINISTRATOR:	MEYERS, BRYAN		FACILITY TYPE:	740
ADDRESS:	655 S MOLLISON AVE		TELEPHONE:	(619) 444-3181
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92020
CAPACITY:	144	CENSUS: 122	DATE:	08/08/2023
		UNANNOUNCED	TIME BEGAN:	11:14 AM
MET WITH:	Sarita Mendoza, Assistant Director		TIME COMPLETED:	12:40 PM

ALLEGATION(S):

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The facility has bed bugs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Renita Hall, conducted an unannounced visit regarding the above-mentioned allegation and delivered findings. LPA was allowed entry by the Assistant Director, Sarita Mendoza. LPA identified herself and disclosed the purpose of the visit and elements of the complaint with the Assistant Director.

The Department investigated the listed complaint allegation. The investigation consisted of a tour of the facility, interviews with staff, residents, and records review, including other relevant evidence pertinent to this investigation such as Pest Control maintenance contract agreement and Inspection Reports.

On August 4, 2023 Community Care Licensing (CCL) received a complaint alleging that facility has bed bugs. The facility has had a service contract with Orkin since 2002 for monthly pest control treatment with previous treatments according to the invoice.
Continued on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Renita Hall	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2023

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-20230804134540

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: CARROLL'S RESIDENTIAL CARE	FACILITY NUMBER: 374604690
	VISIT DATE: 08/08/2023

NARRATIVE

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On July 18, 2023 service invoice indicated that the kitchen was treated and inspected for pest activity, pest control was to be done in the kitchen area and resident rooms 140-150. On August 8, 2023, LPA’s observation and bed inspections of residents revealed no remnant of bedbugs, all mattresses appeared new. Residents interviewed all stated that they did not have bedbugs at the time of visit.

The process for treatment of bedbugs is done by the Director. The Director has bought products for treatment of bedbugs. When bedbugs are discovered, removal all beds from residents’ rooms are replaced with new beds and covered with bed protectors. An interview was conducted with additional staff, who stated that there have not been any bedbugs for couple of months and beds are replaced with new beds and residents are given new sheets. This staff member also stated that residents “do their own laundry.” Residents interviewed did not have bedbugs at the time of visit.

Based on observations, interviews with residents, outside sources, and review of pertinent pest control inspection reports, there was insufficient evidence found to support the allegation that facility has bedbugs. Due to a lack of evidence, the allegation is deemed to be unsubstantiated. A finding that is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Continued

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Renita Hall	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2023

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20230804134540

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: CARROLL'S RESIDENTIAL CARE	FACILITY NUMBER: 374604690
	VISIT DATE: 08/08/2023

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	An exit interview was conducted with the Assistant Director, Sarita Mendoza. A copy of this report and Licensee's Rights (LIC 9058 03/22) were provided to the Sarita Mendoza, Assistant Director and her signature on this report confirms receipt of the Licensee Rights.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Renita Hall	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2023

LIC9099 (FAS) - (06/04)

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