<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157209316
Report Date: 01/09/2025
Date Signed: 01/15/2025 11:47:20 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/03/2024 and conducted by Evaluator Rachel A Bruce
COMPLAINT CONTROL NUMBER: 24-AS-20241003151606
FACILITY NAME:TRINITY, THEFACILITY NUMBER:
157209316
ADMINISTRATOR:LAZAGA, JETHRONELFACILITY TYPE:
740
ADDRESS:200 TRINITY AVETELEPHONE:
(661) 563-1761
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93307
CAPACITY:10CENSUS: 7DATE:
01/09/2025
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Jethronel Lazaga, AdministratorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff inappropriately restrained the residents
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On January 9, 2025, Licensing Program Analyst (LPA), R Bruce conducted a subsequent complaint investigation visit to the facility. During the course of this complaint investigation LPA interviewed staff, clients family, hospice worker, and LPA also obtained and/or reviewed facility records.

It was determined based on the interviews, photographs, and records review that the above allegation is SUBSTANTIATED. Facility did inappropriately restrain a resident in her wheelchair utilizing a bed sheet tied around the client and chair to prohibit and prevent client from falling. There was no indication in the client's file that the doctor or family was made aware or approved.

Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, are being cited on the attached LIC 9099D.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Rachel A BruceTELEPHONE: (559) 470-9001
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025
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 4
Control Number 24-AS-20241003151606
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: TRINITY, THE
FACILITY NUMBER: 157209316
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/17/2025
Section Cited
CCR
87608(a)(1)
1
2
3
4
5
6
7
Postural Support : a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal..., Postural supports may be used under the following conditions.(1) Postural supports shall be limited to appliances or devices such as braces, spring release trays, or soft ties, used to achieve proper body position and balance... This requirement was not met as evidenced by
1
2
3
4
5
6
7
Facility stated they will provide training to staff on proper and improper restraints. Going forward documentation/approval from the doctor and family will be obtained and placed in the client's file when any postural support is used. Proof of training to be submitted to CCL by the due date of
8
9
10
11
12
13
14
The client was tied to her wheelchair with a bedsheet and not an approved postural support device. There was also no approval from her physician for the restraint utilized. This poses a potential risk to the health, safety and personal rights of the client in care.
8
9
10
11
12
13
14
January 17, 2025. Proof will include a sign in sheet, length of training, who provided training, topics covered and who attended.
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Rachel A BruceTELEPHONE: (559) 470-9001
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/03/2024 and conducted by Evaluator Rachel A Bruce
COMPLAINT CONTROL NUMBER: 24-AS-20241003151606

FACILITY NAME:TRINITY, THEFACILITY NUMBER:
157209316
ADMINISTRATOR:LAZAGA, JETHRONELFACILITY TYPE:
740
ADDRESS:200 TRINITY AVETELEPHONE:
(661) 563-1761
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93307
CAPACITY:10CENSUS: 7DATE:
01/09/2025
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Jethronel Lazaga, AdministratorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff caused injuries to a resident by using an improper lift
Staff did not meet a resident's needs while in care
Staff force fed a resident
Staff allowed a resident to be soiled for extended periods of time
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On January 9, 2025, Licensing Program Analyst (LPA) Rachel Bruce conducted a complaint investigation visit to the facility and met with Administrator, Jethronel Lazaga. During this visit LPA delivered investigation findings regarding the above allegations.

The Department has investigated the complaints alleging: Staff caused injury to a resident using an improper lift, Staff did not meet clients needs while in care, Staff force fed a resident and Staff allowed a resident to be soiled for extended periods of time. During the course of the investigation, LPA conducted interviews, reviewed records and conducted facility tour. Based on the interviews conducted and/or records review the above allegations are found to be UNSUBSTANTIATED. Although the allegations may have happened or may be valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Rachel A BruceTELEPHONE: (559) 470-9001
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/03/2024 and conducted by Evaluator Rachel A Bruce
COMPLAINT CONTROL NUMBER: 24-AS-20241003151606

FACILITY NAME:TRINITY, THEFACILITY NUMBER:
157209316
ADMINISTRATOR:LAZAGA, JETHRONELFACILITY TYPE:
740
ADDRESS:200 TRINITY AVETELEPHONE:
(661) 563-1761
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93307
CAPACITY:10CENSUS: 7DATE:
01/09/2025
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Jethronel Lazaga, AdministratorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not have adequate record keeping for a resident
Staff mishandled a resident's medication
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On January 9, 2025, Licensing Program Analyst (LPA) Rachel Bruce conducted a complaint investigation visit to the facility for the purpose of delivering findings. LPA met with Administrator Jethronel Lagaza.

During the course of this investigation LPA reviewed facility files relevant to the complaint investigation as well as interviewing staff, reporting party and family members. It was determined that the above allegations: Staff did not adequately keep a clients records, and staff mishandled a resident's medication, are UNFOUNDED. This agency has found that the complaint was unfounded, and has herefore dismissed the complaint.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Rachel A BruceTELEPHONE: (559) 470-9001
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025
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 4