392700516-8-16-2023-27-AS-KHOS-CV6LM3-20230829085205

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700516
Report Date: 08/16/2023
Date Signed: 08/16/2023 03:46:37 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
03/06/2023 and conducted by Evaluator Michael Bilger

COMPLAINT CONTROL NUMBER: 27-AS-20230306144430

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: 3	DATE:	08/16/2023
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Cindy Lockwood		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Resident sustained a bruise while in care
Staff do not assist resident with bathing
Staff do not assist resident with grooming

INVESTIGATION FINDINGS:

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On 8-16-23 at 3:30pm, Licensing Program Analysts (LPAs) Michael Bilger and Arvin Villanueva arrived unannounced to deliver findings for the complaint allegations noted above. LPAs met with Direct Support Professional (DSP) Cindy Lockwood, and explained the purpose of the visit. Acting Administrator Sylvia Warner was made aware of LPAs visit and gave permission for DSP to sign in her absence. During this investigation, the Department conducted interviews with three residents and 4 staff. The department also conducted interviews with additional witnesses. Additionally, the Department reviewed file documentation including police report, incident reports dating 3-7-23 to 5-17-23, functional capabilities assessment, hospital records, injury reports, 30-day assessment report, physician’s report, individual program plan (IPP), and hygiene logs. Facility observation was conducted on 3-8-23.
Allegation #1: Resident sustained a bruise while in care. Department conducted interviews and reviewed file documentation as noted above. Injury report and incident reports revealed that resident1 (R1) has a history of bruising which has been addressed by facility accordingly through hospital visits, general first aid, and continued observation.

{Cont. on 9099C}

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20230306144430

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: 08/16/2023

NARRATIVE

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Based on interviews conducted, it was revealed that staff where unaware of how R1 could have sustained bruising. Interviews also revealed that residents in care denied ever being abused by staff, and witnessing staff ever hit or abuse R1 in any way. Staff interviews further revealed that R1 has a blood disorder which causes R1 to bruise easily. Based on file documentation reviewed including hospital records, it was revealed that R1 is diagnosed with Thrombocytopenia. According to National Heart, Lung, and Blood Institute: Thrombocytopenia is a condition that occurs when platelet count in your blood is too low. Major symptoms of Thrombocytopenia is, easy bruising, abnormal bleeding such as nose bleeds, blood in urine or excrement, pinpoint bleeding in the skin that looks purplish-red, cuts that keep bleeding, and feeling tired.
Based on interviews and record reviews, the Department has determined that there is not a preponderance of evidence to conclude that bruising or other unexplained injuries occurred while in care due to neglect or lack of care and supervision. Therefore, this allegation is UNSUBSTANTIATED.

Allegation #2: Staff do not assist resident with bathing. The Department conducted interviews, observation, and file documentation reviews as noted above. Based on interviews conducted with staff and residents living at the facility, it was revealed that R1 received showering assistance daily and observed to be clean with no foul odors noted. A hygiene log was reviewed which supported this claim. Additionally, appropriate bathing supplies were observed in R1’s bedroom and available to staff for use. Based on interviews and record reviews, the Department has determined that there is not a preponderance of evidence to conclude R1 was not receiving bathing assistance. Therefore, this allegation is UNSUBSTANTIATED.

Allegation #3: Staff do not assist resident with grooming. The Department conducted interviews, observation, and file documentation reviews as noted above. Based on interviews conducted with staff and residents living at the facility, it was revealed that R1 received grooming assistance daily and observed to be clean with appropriately groomed and clothed according to current temperature conditions. A hygiene log was reviewed which supported this claim. Additionally, grooming supplies were observed in R1’s bedroom and available to staff for use. Based on interviews and record reviews, the Department has determined that there is not a preponderance of evidence to conclude R1 was not receiving grooming assistance. Therefore, this allegation is UNSUBSTANTIATED.

An exit interview was conducted with Cindy Lockwood and a copy of this report was provided to Cindy. Appeal rights provided.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2023

LIC9099 (FAS) - (06/04)

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