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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604690
Report Date: 06/12/2024
Date Signed: 06/12/2024 01:44:48 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
06/11/2024 and conducted by Evaluator Renita Hall
COMPLAINT CONTROL NUMBER: 08-AS-20240611143909
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: 125DATE:
06/12/2024
UNANNOUNCEDTIME BEGAN:
01:22 PM
MET WITH:Brian Meyers, AdministratorTIME COMPLETED:
01:50 PM
ALLEGATION(S):
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9
Staff did not ensure residents were seen by a physician
Staff are threatening resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Renita Hall, conducted an unannounced visit regarding the above-mentioned allegations. LPA was allowed entry by Brian Meyers, Administrator. LPA identified herself and disclosed the purpose of the visit and elements of the complaint with the Administrator and delivered findings.

On June 12, 2024, the Department investigated the above-listed complaint allegations. The investigation consisted of a tour of the facility and interviews with staff and resident. Resident 1 (R1) admitted that they were at fault for not staying in line to see the physician. R1 also admitted that they were upset when they went into the office to talk to the Administrator who knew nothing about the appointment for seeing the physician. R1 stated they went to calm down and spoke with the Administrator later the same day to resolve the issue. The Administrator was in a meeting when R1 entered the office screaming and using profanity. R1 was told that the disrespect would not be tolerated and goes against facility policy and eviction would be the next step if continued. No eviction notice has been given to R1.
Continued on 9099C


Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
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-20240611143909
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: 06/12/2024
NARRATIVE
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Based on the investigation findings, the allegations made against the facility 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 violations occurred.

An exit interview was conducted with Brian Meyers, Administrator. A copy of this report and Licensee's Rights (LIC 9058 03/22) were provided to the Administrator and his signature on this report confirms receipt of the Licensee Rights.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2