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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604690
Report Date: 03/05/2024
Date Signed: 03/05/2024 12:44:52 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
02/26/2024 and conducted by Evaluator Renita Hall
COMPLAINT CONTROL NUMBER: 08-AS-20240226154315
FACILITY NAME:CARROLL'S RESIDENTIAL CAREFACILITY NUMBER:
374604690
ADMINISTRATOR:MEYERS, BRYANFACILITY TYPE:
740
ADDRESS:655 S MOLLISON AVETELEPHONE:
(619) 444-3181
CITY:EL CAJONSTATE: CAZIP CODE:
92020
CAPACITY:144CENSUS: 123DATE:
03/05/2024
UNANNOUNCEDTIME BEGAN:
11:49 AM
MET WITH:Sarita Mendoza, Assistant ManagerTIME COMPLETED:
12:50 PM
ALLEGATION(S):
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Facility plumbing is in disrepair.
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 February 26, 2024, a complaint was received by the Department on Carroll's Residential Facility regarding the state of the plumbing in the facility,it claimed that the plumbing was in disrepair.

On March 4, 2024, LPA spoke with the complainant who reported maintenance and housekeeping promptly addressed the issue and the plumbing was no longer a concern. Following the repair, complainant expressed satisfaction with the prompt response and resolution of the issue. They indicated that they were no longer concerned about the state of the plumbing in the facility and wished to withdraw their complaint.

Continued on 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Renita HallTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 08-AS-20240226154315
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: 03/05/2024
NARRATIVE
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Based on the investigation findings, the allegation made against the staff of Carroll's Residential Care regarding the facility plumbing being in disrepair was found to be unsubstantiated as the issue was promptly addressed and resolved.

An exit interview was conducted with Sarita Mendoza, 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 PowellTELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Renita HallTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2