374604690-12-12-2023-08-AS-DPOL-CYQP5V-20231221100122

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604690
Report Date: 12/12/2023
Date Signed: 12/12/2023 12:09:56 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
12/08/2023 and conducted by Evaluator Renita Hall

COMPLAINT CONTROL NUMBER: 08-AS-20231208091532

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: 125	DATE:	12/12/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Sarita Mendoza, Assistant Manager		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff did not meet a resident's incontinence needs

INVESTIGATION FINDINGS:

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

On December 8, 2023, an allegation was made against Carroll's Residential Care regarding the staff not meeting a resident's incontinence needs. LPA Hall interviewed the resident and staff members who may have witnessed or had relevant information regarding the incident. LPA reviewed relevant documentation, including resident care plans, and other relevant records. LPA observed the facility's operations, staff interactions with residents, and the overall environment.

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: 12/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

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-20231208091532

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: 12/12/2023

NARRATIVE

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Allegation: Staff did not meet a resident's incontinence needs. No evidence was found to support the claim after conducting interviews with the resident and staff members. The resident's physician report indicated that the resident is capable of meeting their incontinence care with no additional assistance needed. Resident 1 (R1) stated that they can manage their Activities of Daily Living (ADLs) with no assistance but if needed they will ask staff to assist.

Based on the investigation findings, the allegation made against the staff of Carroll's Residential Care regarding staff not meeting a resident's incontinence needs is 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.

An exit interview was conducted with the Assistant Manager. A copy of this report and Licensee's Rights (LIC 9058 03/22) were provided to the Assistant Manager 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: 12/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

LIC9099 (FAS) - (06/04)

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