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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604690
Report Date: 08/27/2026
Date Signed: 08/27/2026 11:29:42 AM

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
08/18/2026 and conducted by Evaluator Tiffany Holmes
COMPLAINT CONTROL NUMBER: 08-AS-20260818085329
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:
08/27/2026
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Pam Pineiro, Admissions Coordinator &
Sarita Mendoza, House Manager		TIME COMPLETED:
11:38 AM
ALLEGATION(S):
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Staff did not provide adequate supervision resulting in resident eloping from facility.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced visit to open the above complaint allegation. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Pam Pineiro, Admissions Coordinator. Sarita Mendoza, House Manager arrived during the visit.

The complainant alleged the staff did not provide adequate supervision resulting in resident eloping from facility. Resident #1 (R1) [See LIC811 Confidential Names List for a description of select person identifiers used in this report.] During the course of the investigation, LPA Holmes conducted a tour of the facility, welfare check on residents in care, reviewed pertinent client care records, and personnel records. and conducted interviews.

Interviews revealed that on August 20, 2026 R1 left the facility before dinner. Interviews revealed that on that day R1 took their morning medications at 7:15 am, took their noon medications at 11 am and missed dinner medications at 4:15 pm and their bedtime medications at 7:15 pm. Interviews revealed that R1 is med- complaint. Interviews and observations of R1’s appraisal/ needs and service plan from January 10, 2018 reports that R1 has a history of AWOLing.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2026
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-20260818085329
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: 08/27/2026
NARRATIVE
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According to R1's physicians report dated January 24, 2018 it states that the resident is not confused or disoriented, it states that R1 does not have wandering behavior, that R1 is able to communicate needs and that they are able to leave the facility unassisted. Interviews revealed there is no record of anyone bringing R1 back to the facility on or around August 18, 2026. Interviews did reveal that on August 20, 2026 R1 left the facility and did not return. The facility completed and filed a missing persons report with the El Cajon Police Department on August 21, 2026. They received a case number from the police department. Upon observation it was observed that the facility staff are following their absentee notification plan. Interviews revealed that on August 23, 2026 R1s primary care doctor informed the facility that R1 was at the hospital. The staff removed R1 from the missing persons system. Interviews revealed that R1 is still at the hospital as of this visit.

Interviews revealed they have 19 staff daily with 15 that work directly with the residents and that all staff have been trained on care and supervision and the last training was on August 14, 2026. The staff follow protocol on supervising the residents. Interviews with staff denied not supervising the residents.

Based on records, and interviews, a preponderance of evidence does not exist to show the staff did not provide adequate supervision resulting in resident eloping from facility. Therefore, the allegation is Unsubstantiated, meaning the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted with Sarita Mendoza, House Manager, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2