392700516-2-2-2022-27-AS-KHOS-CBBNAN-20220204091751

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700516
Report Date: 02/02/2022
Date Signed: 02/02/2022 05:16:09 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/13/2022 and conducted by Evaluator Michael Bilger

COMPLAINT CONTROL NUMBER: 27-AS-20220113133613

FACILITY NAME:	DE TRIO HEALTH CARE		FACILITY NUMBER:	392700516
ADMINISTRATOR:	BONNER, WILLIAM		FACILITY TYPE:	735
ADDRESS:	905 W. MAGNOLIA		TELEPHONE:	(209) 639-5134
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95203
CAPACITY:	4	CENSUS: 4	DATE:	02/02/2022
		UNANNOUNCED	TIME BEGAN:	01:32 PM
MET WITH:	Sylvia Warner		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Resident's hygiene needs are not being met
Resident is not groomed
Resident not appropriately dressed while in facility's care
Residents are not provided with sufficient meals
Residents are not given activities while in facility's care

INVESTIGATION FINDINGS:

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On 2-2-22 at 1:32pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to continue investigation for the complaint allegations noted above. LPA met with Sylvia Warner and explained the purpose of the visit. Denica Layne, facility manager was notified by phone, who notified licensee to give permission for Syliva to accommodate LPA and sign paperwork. LPA conducted COVID screening questions prior to entry. During the course of this investigation, LPA interviewed Staff1 (S1) and S2. LPA also interviewed and conduced a wellness observation check for Client1 (C1) on 1/18/22 . On 2-22-22, LPA interviewed C2, C3, and C4. On 1/18/22, LPA reviewed Individualized Program Plan (IPP) for C1, conducted facility observation, and reviewed facility’s menu. On 2-2-22, LPA conducted a second facility observation as well as a second wellness observation check for C1. LPA also reviewed facility care notes for R1 on 2-2-22. Additional interviews were conducted with complainant on 1-14-22.
Allegation #1: Resident’s hygiene needs are not being met. LPA reviewed facility’s care notes, conducted interview with C1, C2, C3, and C4 and conducted facility observation. LPA also conducted wellness observation check for C1. LPA also interviewed S1, S2 and complainant. {Cont. on 9099C}

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022

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 3

Control Number 27-AS-20220113133613

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: DE TRIO HEALTH CARE	FACILITY NUMBER: 392700516
	VISIT DATE: 02/02/2022

NARRATIVE

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Based on interviews and observation, it was determined that clients have been receiving adequate hygiene needs. Observations and interviews revealed that clients in care have adequate access to hygiene materials and receiving assistance as needed from staff. Observation of C1 also revealed that teeth and hair appeared clean, and no strong odors were noted to indicate a lack of hygiene for C1. Based on interviews, observations, and record review it is determined that the preponderance of evidence standard is not met and therefore, this allegation is UNSUBSTANTIATED.

Allegation #2: Resident is not groomed. LPA reviewed facility’s care notes, conducted interview with C1, C2, C3, and C4 and conducted facility observation. LPA also interviewed S1, S2, and complainant. LPA also conducted wellness observation check for C1. Based on observation and interview, it was determined that C1 has toenails and fingernails of adequate length. Hair and facial hair for C1 appeared to be groomed adequately during observations. Interviews with clients and staff revealed that assistance is provided as needed for grooming needs. LPA also observed grooming supplies on hand at facility. Based on observations, interviews, and record review, basic grooming needs appear to be met. It is determined that the preponderance of evidence standard is not met and therefore, this allegation is UNSUBSTANTIATED.

Allegation #3: Resident is not appropriately dressed while in facility’s care. . LPA reviewed facility’s care notes, conducted interview with C1, C2, C3, and C4 and conducted facility observation. LPA also interviewed S1, S2, and complainant. LPA also conducted wellness observation check for C1. Based on observations, interviews, and record reviews it was determined that adequate clothing exist in clients closets. Additionally, it appears through observations that clients were appropriately dressed while in facility. Clothing observed included, but not limited to jackets, t-shirts, pants, and additional clothing suitable for various seasons throughout the year. Care notes and interviews revealed facility is assisting clients with clothing choices as needed. Based on interviews, observations, and record review, it is determined that the preponderance of evidence standard is not met and therefore, this allegation is UNSUBSTANTIATED.

{Cont. on 9099C}

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 27-AS-20220113133613

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: DE TRIO HEALTH CARE	FACILITY NUMBER: 392700516
	VISIT DATE: 02/02/2022

NARRATIVE

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Allegation #4: Residents are not provided with sufficient meals. LPA reviewed facility’s menu and conducted interviews with C1, C2, C3, and C4. LPA also conducted interviews with S1, S2, and complainant. Additionally, LPA conducted observation of meal prep and observation of food supply. Based on observation, record review and interviews, it was determined that food on hand matches the scheduled menu items. Observation of meal prep revealed adequate portions of food are available to clients in care. Interviews revealed food amounts including fruits and vegetables are adequate for clients and enjoyed by clients. Based on record review, interviews, and observations it is determined that the preponderance of evidence standard is not met and therefore, this allegation is UNSUBSTANTIATED.

Allegation #5: Residents are not given activities while in facility’s care. LPA reviewed facility’s activity calendar and conducted interviews with C1, C2, C3, and C4. LPA also conducted interviews with S1, S2, and complainant. Additionally, LPA conducted facility observations. Based on observations, interviews, and record reviews, it is determined that scheduled activities and outings are in place for clients. A record review revealed an outings schedule separate from established facility activities calendar. Interviews with clients revealed clients are aware of scheduled activities and receive offers of activities from facility staff, although not all clients consistently wish to participate. A facility observation by LPA revealed activities are offered and conducted with participation by various clients. Clients were also observed by LPA to enjoy private leisure time. Based on record review, interviews, and observations it is determined that the preponderance of evidence standard is not met and therefore, this allegation is UNSUBSTANTIATED.

An exit interview was conducted with Sylvia Warner and a copy of this report was left with Sylvia. Appeal rights provided.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022

LIC9099 (FAS) - (06/04)

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