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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604308
Report Date: 04/23/2025
Date Signed: 04/23/2025 04:11:49 PM

Substantiated


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
04/01/2025 and conducted by Evaluator Hannah Rodgers
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20250401102352
FACILITY NAME:CARLOVY HOMES IN CARLSBADFACILITY NUMBER:
374604308
ADMINISTRATOR:RADOVANIC, ANAFACILITY TYPE:
740
ADDRESS:1275 CYNTHIA LANETELEPHONE:
(623) 341-2794
CITY:CARLSBADSTATE: CAZIP CODE:
92008
CAPACITY:6CENSUS: 5DATE:
04/23/2025
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Head Caregiver Manny RodriguezTIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Facility staff locked resident in their bedroom
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Hannah Rodgers conducted an unannounced visit to deliver findings regarding the above complaint allegation. LPA introduced themselves and disclosed the purpose of the visit to Head Caregiver Manny Rodriguez.

On April 1, 2025, it was alleged that the facility staff locked a resident in their bedroom. The Department’s investigation consisted of an unannounced facility visit, interviews with facility staff and residents, outside sources, and records review.

According to the allegation, Resident #1 (R1) was being locked into their bedroom at night via a locking mechanism that locks the bedroom door from the outside. It was also alleged that R1 was being locked in their bedroom at night due to their wandering behaviors, that were primarily exhibited during the night hours.
[Continued on LIC9099-C]
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Hannah Rodgers
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025
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 5
Control Number 08-AS-20250401102352
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: CARLOVY HOMES IN CARLSBAD
FACILITY NUMBER: 374604308
VISIT DATE: 04/23/2025
NARRATIVE
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R1’s physician’s report dated March 12, 2025, confirmed R1 was diagnosed with Alzheimer’s Disease, had sundowning behavior, was unable to follow instructions, and required staff assistance for all activities of daily living (ADLs). R1 was unable to be used a reliable historian to aid in this investigation due to their baseline memory loss.

Records review revealed that on April 3, 2025, local law enforcement conducted a visit to the facility during the night hours. Per the police report, a tour of the facility and interviews with staff and residents were conducted. Interviews with staff revealed that the facility staff had installed a lock on R1’s door and was locking R1 into their bedroom, from the outside, during the nighttime hours. Interviews with staff revealed R1’s wandering behaviors are primarily prominent during the night hours.

On April 4, 2025, LPA accompanied by staff, toured the interior of the facility and inspected each bedroom. LPA observed R1’s bedroom door with a lock on the doorknob that could be locked from the outside via a key. LPA observed R1 to be unaware of their surroundings. LPA was unable to qualify R1 for interview.

Based on direct LPA observations, interviews, and records reviewed, a preponderance of evidence exists to support the allegation. One deficiency is being cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D). An exit interview was conducted with Head Caregiver Manny Rodriguez, to whom a copy of this report, LIC 9099-C, LIC 9099-D, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided to.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Hannah Rodgers
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 08-AS-20250401102352
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: CARLOVY HOMES IN CARLSBAD
FACILITY NUMBER: 374604308
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/21/2025
Section Cited
CCR
87468.1(a)(6)
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87468.1(a)(6) Personal Rights of Residents in All Facilities (a) residents… shall have all of the following personal rights (6) … to not be locked in any room, building, or on facility premises by day or night… This requirement has not been met as evidenced by:
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Licensee agrees to remove locking doorknob by the date of 4/24/25 and send the Department proof of removal. Licensee agrees to conduct an in-service training on the personal rights of residents and submit a sign-in sheet and topic agenda to the Department by POC date of 5/21/25.
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Based on interviews, records review, and observations the licensee did not comply with the section above in that one (1) out of five (5) residents were locked in their bedroom at night, which posed a potential personal rights risk.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Hannah Rodgers
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
04/01/2025 and conducted by Evaluator Hannah Rodgers
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20250401102352

FACILITY NAME:CARLOVY HOMES IN CARLSBADFACILITY NUMBER:
374604308
ADMINISTRATOR:RADOVANIC, ANAFACILITY TYPE:
740
ADDRESS:1275 CYNTHIA LANETELEPHONE:
(623) 341-2794
CITY:CARLSBADSTATE: CAZIP CODE:
92008
CAPACITY:6CENSUS: 5DATE:
04/23/2025
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Head Caregiver Manny RodriguezTIME COMPLETED:
10:45 AM
ALLEGATION(S):
1
2
3
4
5
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7
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9
Facility staff were sleeping while on duty
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Hannah Rodgers conducted an unannounced visit to deliver findings regarding the above complaint allegation. LPA introduced themselves and disclosed the purpose of the visit to Head Caregiver Manny Rodriguez.

On April 1, 2025, it was alleged that the facility staff were sleeping while on duty. The Department’s investigation consisted of an unannounced facility visit, interviews with facility staff and residents, outside sources, and records review. According to the allegation, the caregivers were asleep while they should have been providing care and supervision to residents.

[Continued on LIC9099-C]
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Hannah Rodgers
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 08-AS-20250401102352
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: CARLOVY HOMES IN CARLSBAD
FACILITY NUMBER: 374604308
VISIT DATE: 04/23/2025
NARRATIVE
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Interviews with residents did not reveal any concerns with the staff not providing care while on duty nor did the interviews reveal that resident needs were not being met. Interviews with outside sources revealed that there have been consistently at least two staff members at the facility providing care and supervision. Interviews with outside sources did not reveal the observation of staff sleeping while on duty. Interviews with residents, staff, and outside sources did not reveal that staff members were asleep while they should have been on providing care and supervision. The records reviewed by LPA did not reveal a specified staff ratio requirement for one-on-one continuous care for any residents nor did it reveal a need for additional overnight supervision.

Based on interviews and record review, the investigation did not yield a preponderance of evidence to conclude that the facility staff were sleeping while on duty. Based on the foregoing, the allegation is unsubstantiated. This finding means that although the allegation may have happened or may be valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Head Caregiver Manny Rodriguez, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Hannah Rodgers
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5