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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602385
Report Date: 10/14/2024
Date Signed: 10/14/2024 02:27:53 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/09/2024 and conducted by Evaluator Perry Scott
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20240909145807
FACILITY NAME:TRINITY HOMES IIFACILITY NUMBER:
198602385
ADMINISTRATOR:AYOARIYO, GEORGEFACILITY TYPE:
735
ADDRESS:20331 CARON CIRCLETELEPHONE:
(310) 933-8447
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY:4CENSUS: 4DATE:
10/14/2024
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Oluwarotim JohnsonTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff caused injuries to a client.


INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 09/10/24, at 8:45am, Licensing Program Analyst (LPA) Perry Scott conducted a Health and Safety complaint visit to the facility and was greeted by Oluwarotim Johnson, House Manager, and George Ayoariyo, Licensee. LPA explained the purpose of this visit is to conduct interviews, gather facility files and to do a Health and Safety tour of the facility.

The investigation consisted of the following: LPA investigated the allegations mentioned in this complaint, completed a Health and Safety tour of the facility, and conducted interviews with staff (S1-S4) and clients (C1-C3). Additionally, LPA obtained the following facility documents: Client Roster (Dated: 11/28/2023), Staff Roster (Dated: 07/31/2024), and Pictures of the Incident (Dated: 08/27/2024). LPA obtained documents for C1: Face Sheet (Dated: 06/12/2023) Admission Agreement (Dated: 07/28/2023), IPP (Dated: 10/20/2023) Psychological Evaluation (Dated: 07/24/08 & 09/17/07) Physicians Report (Dated: 05/22/2024 & 08/27/2024), ID/Emergency Information (Dated: 12/10/2023), and Special Incident Reports (SIR’s) (Dated: 08/27/24, 08/28/24, 06/30/24,03/20/24, 02/22/24, 01/30/24, 01/24/24, 12/18/23, 12/02/23, 11/15/23, 11/12,23, 10/29/23, 09/16,23, 09/05/23, 08/10/23, 08/09/23, & 07/30/23).

Report continued on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2024
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 7
Control Number 11-AS-20240909145807
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: TRINITY HOMES II
FACILITY NUMBER: 198602385
VISIT DATE: 10/14/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The investigation revealed the following: Allegation #1- Staff caused injuries to a client.

The details of the complaint alleged that the facility requested that C1 get C1’s blood pressure checked. It is alleged that C1 was irritable and refused, then staff held C1 to take blood pressure. Afterwards, C1 broke a coffee mug over S4’s head, a struggled ensued, and S4 bit C1 to get C1 off S4. On 09/10/24, from 08:46am-10:30am, LPA interviewed staff (S1-S3); on 09/13/24 LPA interviewed client (C1); on 09/16/24 LPA interviewed staff (S4); and on 10/11/24 at 11:00am LPA interviewed clients (C2-C3), regarding the allegations. 2 of 4 staff corroborated the allegation that Staff caused injuries to a client. All staff (S1-S4) stated that on 08/27/24 there was an incident in the facility causing staff member S4 to be taken to urgent care for a wound injury that needed stitches because client (C1) broke a coffee mug over (S4’s) head causing injury to S4’s head and feet. Staff (S1-S4) stated that C1 was agitated and talking loudly about things that weren’t clear and had run out of the facility. Staff got C1 to come back inside the facility and they stated they were asking C1 to calm down when C1 grabbed a coffee cup and smashed it upon S4’s head causing lacerations to S4’s head and feet that needed stitches. Staff stated that there was a struggle between the two and they were trying to break it up. They state that C1 was trying to stab S4 with a piece of the broken cup and in the struggle to get C1 off S4, staff (S4) admitted that S4 feared for S4’s life and bit C1 to prevent further attacks upon S4. Staff stated that it did not have anything to do with taking C1s blood pressure rather it involved C1s behavior on that day.

Staff stated that they did not know that C1 had any injuries during the struggle. They asked if C1 was okay and if C1 wanted to go to the hospital, C1 said no. It wasn’t brought to their attention until the next day, stated S1, that staff discovered that C1 had bruises and a bite mark. S1 stated that they took C1 to the hospital on 08/28/24. S1 stated that staff wanted to take photos but C1 denied their request. Staff (S2-S3) stated that they did not know if S4 bit C1 during the struggle. LPA reviewed a physician’s report dated 08/27/24 where it is noted that C1 had sustained an accidental bite by another person. LPA reviewed prior Special Incident Reports dated 08/27/24, 06/30/24, 02/22/24, 01/24/24, &12/02/23 where C1 has physically and verbally attacked staff members, and displayed aggressive behavior by trying to kick, punch, and spit on them. Additionally, LPA reviewed a Psychological Evaluation dated 09/17/07, that states C1 is unable to resolve conflicts, becomes angry and frustrated easily, and has difficulties with following directions.

Report continued on LIC9099-C

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2024
LIC9099 (FAS) - (06/04)
Page: 7 of 7
Control Number 11-AS-20240909145807
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: TRINITY HOMES II
FACILITY NUMBER: 198602385
VISIT DATE: 10/14/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA interviewed clients C1-C3 about the allegation and 1 of 3 clients that were interviewed corroborated the allegation that Staff caused injuries to a client. Client stated that they were bit and bruised during an altercation with staff members on 08/27/24. C1 stated that C1 hit staff S4 with a coffee cup and had a struggle with S4 and other staff tried to separate them during which C1 was bit and bruised in the struggle. Clients (C2-C3) stated they were not there during the incident and acknowledged they have never been injured by staff.

Based on interviews conducted and records reviewed, the preponderance of evidence standard has been met. Therefore, the above allegation Staff caused injuries to a client, is found to be Substantiated. California Code of Regulations, Title 22, Division (6) and chapter (1) are being cited on the attached LIC 9099D. An Immediate $500 civil penalty is assessed.

Note: *Citations not cleared by the due date will have a $100 fine assessed for each citation until it is cleared. Civil penalties will continue to accrue until Proof of Corrections (POC) is cleared.

A citation was issued, and plans of corrections were discussed.



An exit interview was conducted with Oluwarotim Johnson, House Manager, and a copy of this Complaint Investigation Report and appeal rights were provided.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 11-AS-20240909145807
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: TRINITY HOMES II
FACILITY NUMBER: 198602385
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/14/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/25/2024
Section Cited
CCR
80072(a)(2)(3)
1
2
3
4
5
6
7
80072(a)(2)(3) Personal Rights (a) Except for children’s residential facilities, each client shall have personal rights... (2) To be accorded safe, healthful, and comfortable accommodations… (3) To be free from corporal or unusual punishment, infliction of pain, humiliation…. This requirement was not met as evidence by:
1
2
3
4
5
6
7
Administrator will provide in-service training to all staff for the following topics: Clients personal rights Title 22 80072(a)(2)(3), de-escalating techniques, and techniques to redirect behaviors and provide sign in sheet with training subject, printed and signed names of staff attending, and submit to LPA by POC due date 10/25/24. Submit by email to perry.scott@dss.gov to avoid monetary penalties.
8
9
10
11
12
13
14
Based on interviews and records reviewed, the facility failed to safeguard the client from being bitten by staff while in a struggle to control client. This violation poses a potential health and safety to clients in care.
8
9
10
11
12
13
14
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.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/09/2024 and conducted by Evaluator Perry Scott
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20240909145807

FACILITY NAME:TRINITY HOMES IIFACILITY NUMBER:
198602385
ADMINISTRATOR:AYOARIYO, GEORGEFACILITY TYPE:
735
ADDRESS:20331 CARON CIRCLETELEPHONE:
(310) 933-8447
CITY:CARSONSTATE: CAZIP CODE:
90746
CAPACITY:4CENSUS: 4DATE:
10/14/2024
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Oluwarotim JohnsonTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff inappropriately restrained a client.
Staff intimidated a client.
Staff denied a client from using the telephone.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Allegation #2 Staff inappropriately restrained a client.

The details of the complaint alleged that staff inappropriately restrained client to have clients blood pressure checked when client refused. On 09/10/24, from 08:46am-10:30am, LPA interviewed staff (S1-S3); on 09/13/24 LPA interviewed client (C1); on 09/16/24 LPA interviewed staff (S4); and on 10/11/24 at 11:00am, LPA interviewed clients (C2-C3) regarding the allegations. 4 of 4 staff (S1-S4) denied the allegation that the Staff inappropriately restrained a client. All staff (S1-S4) stated that the incident did not involve having the client’s blood pressure checked, it involved the client assaulting a staff member. All staff deny that they restrained C1. Staff stated that C1 smashed a cup over staff member S4’s head causing injury to both S4’s head and feet when S4 stepped into the chards of the coffee cup. Staff stated that they were trying to stop C1 from hurting S4 any further by trying to pull C1 off S4, and at no time did they restrain C1.

Report continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 11-AS-20240909145807
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: TRINITY HOMES II
FACILITY NUMBER: 198602385
VISIT DATE: 10/14/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA interviewed clients (C1-C3) about the allegation and 1 of 3 clients that were interviewed corroborated the allegation that the Staff inappropriately restrained a client. C1 stated that staff restrained C1 because C1 was having a struggle with S4 after hitting S4 with a coffee cup over the head. While clients (C2-C3) denied that they have ever been restrained and was not a witness to this incident.

Based on interviews, there is insufficient evidence to support the allegation that the Staff inappropriately restrained a client. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

Allegation #3- Staff intimidated a client.

The details of the complaint alleged that after an altercation with staff (S4) where S4 was struggling with client (C1) after having a coffee cup smashed over S4’s head; the staff S4 tried to intimidate C1 by standing up and staring at C1 in a way that felt intimidating. On 09/10/24, from 08:46am-10:30am, LPA interviewed staff (S1-S3); on 09/13/24 LPA interviewed client (C1); on 09/16/24 LPA interviewed staff (S4); and on 10/11/24 at 11:00am LPA interviewed clients (C2-C3) regarding the allegations. 4 of 4 staff (S1-S4) denied the allegation that the Staff intimidated a client. All staff (S1-S4) interviewed stated that they did not try to intimidate C1 because of the incident. They state that after the altercation they asked if C1 was okay, if C1 needed to go to the hospital, and tried to calm C1 down; and at no time did anyone try and intimidate C1. S4 stated that S4 did not try and intimidate C1 after they struggled. S4 stated that S4 got up from the floor bleeding from the head injury and tried to attend to S4’s wound and did not try to intimidate C1 afterwards.

LPA interviewed clients (C1-C3) about the allegation and 1 of 3 clients that were interviewed corroborated the allegation that the Staff intimidated a client. C1 stated that C1 felt C1 was being intimidated because of the way S4 was staring at C1. While clients (C2-C3) stated that they have never been intimidated by staff and was not a witness to this incident.

Based on interviews, there is insufficient evidence to support the allegation that the Staff intimidated a client. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

Report continued on LIC9099-C

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 11-AS-20240909145807
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: TRINITY HOMES II
FACILITY NUMBER: 198602385
VISIT DATE: 10/14/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegation #4- Staff denied a client from using the telephone.

The details of the complaint alleged that the staff got upset with C1 for trying to call 911 the day of the incident and has removed C1’s phone privileges. On 09/10/24, from 08:46am-10:30am, LPA interviewed staff (S1-S3); on 09/13/24 LPA interviewed client (C1); on 09/16/24 LPA interviewed staff (S4); and on 10/11/24 at 11:00am LPA interviewed clients (C2-C3) regarding the allegations. 4 of 4 staff (S1-S4) denied the allegation that the Staff denied a client from using the telephone. All staff (S1-S4) interviewed stated that they did not remove C1’s phone privileges and has never done anything like that. All staff stated that C1 has a cell phone and uses it freely without constraint. Staff also state that any client is also free to use the facility phone.

LPA interviewed clients (C1-C3) about the allegation and 3 of 3 clients that were interviewed denied the allegation that the Staff denied a client from using the telephone. Clients (C1-C3) stated that the staff has never denied them use of the phone nor have removed any privileges to use the phone. C1 stated that C1 has a cellphone and uses it at any time.

Based on interviews, there is insufficient evidence to support the allegation that the Staff denied a client from using the telephone. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

No deficiencies were cited.

An exit interview was conducted with Oluwarotim Johnson, House Manager, and a copy of this Complaint Investigation Report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 7