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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374603890
Report Date: 12/23/2022
Date Signed: 12/23/2022 12:47:52 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
07/02/2021 and conducted by Evaluator Tiffany Holmes
COMPLAINT CONTROL NUMBER: 08-AS-20210702121823
FACILITY NAME:TRINITY CARE HOMESFACILITY NUMBER:
374603890
ADMINISTRATOR:YARINN GONZALEZFACILITY TYPE:
735
ADDRESS:104 COLBERT DRIVETELEPHONE:
(619) 750-7663
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY:4CENSUS: 4DATE:
12/23/2022
UNANNOUNCEDTIME BEGAN:
11:36 AM
MET WITH:Yarinn Gonzalez, AdministratorTIME COMPLETED:
12:05 PM
ALLEGATION(S):
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Staff did not prevent resident from self harming.
Facility illegally evicted resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA)Tiffany Holmes conducted an unannounced complaint visit to the facility to deliver findings on the above-mentioned allegations. LPA gained access to the facility, identified herself, and met with Yarinn Gonzalez, Administrator to discuss the purpose of the visit.

LPA conducted the initial investigation visit on July 7, 2021 and conducted interviews, made observations, and obtained and reviewed pertinent records. It was alleged that staff did not prevent resident from self harming. Interviews revealed that on or around July 1, 2021 Client 1 (C1) got upset with Staff 1 (S1) and grabbed a pencil and attacked S1. C1 stabbed S1 with the pencil after hitting S1 multiple times. Interviews revealed that C1 became verbally aggressive and confrontational with S1 after inquiring about why the internet was off. Interviews revealed that C1 has a history of being verbally and phyiscally abusive towards staff. C1s Individual Placement Plan (IPP) shows that C1 has a history of assault with peers and staff.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2022
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-20210702121823
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: TRINITY CARE HOMES
FACILITY NUMBER: 374603890
VISIT DATE: 12/23/2022
NARRATIVE
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Documents observed revealed that C1 needs constant supervision and that C1 is non compliant daily.

It was alleged that the facility illegally evicted resident. Interviews revealed that the administrator did submit a 3 day notice on July 1, 2021 after the incident and C1 attacking S1. Interviews also revealed that the 3 day notice was rescinded due to staff wanting to work with C1 and their responsible party. Interviews revealed that C1 went to the hospital after the incident and returned back to the facility after their hold. Interviews revealed that San Diego Regional Center was involved and aware of the incident and started looking for another placement but could not at the time due to covid.

The allegation is unsubstantiated.

An exit interview was conducted with Yarinn Gonzalez and a copy of this report along with Licensee/Appeal Rights (LIC 9058 03/22) was provided at the conclusion of the visit.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2