392700516-1-27-2023-27-AS-LKIG-CNTQNM-20230207111923

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 392700516
Report Date: 01/27/2023
Date Signed: 01/27/2023 04:24:39 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
12/14/2022 and conducted by Evaluator Michael Bilger

COMPLAINT CONTROL NUMBER: 27-AS-20221214082523

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:	01/27/2023
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Denica Layne		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Alleged abuse of resident by facility staff

INVESTIGATION FINDINGS:

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On 1-27-23 at 2:30pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver investigation findings for the allegation list above. LPA met with assistant administrator Denica Layne and explained the purpose of the visit. Administrator William Bonner was made aware of visit and gave permission for Denica to sign in hs absence. During this investigation, LPA conducted interviews with resident1 (R1), Staff1 (S1), S2, and S3. LPA also interviewed additional witnesses. Additionally, LPA reviewed facility file documentation including physician’s report for R1, individualized program plan (IPP) for R1, staff chart notes, medical appointment information, staffing records, police call log, and camera footage provided by facility. Allegation above refers to alleged physical abuse by staff towards R1.
Based on interviews and record reviews, it was revealed that on 12-7-22, R1 was witnessed to be experiencing a behavioral episode upon exiting the transportation vehicle and required intervention by staff member on duty. It was further revealed that additional staff was on duty and present during the behavioral episode. Additionally, other witnesses were in the vicinity of the episode to inquire. Available camera footage reviewed reveals staff member standing over R1 without advanced movement towards R1. {Cont. on 9099C}

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023

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-20221214082523

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: 01/27/2023

NARRATIVE

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Interviews conducted resulted in non-corroboration and undetermined statements of the allegation of staff member making contact with R1 in a physically abusive manner.

As a result, the above allegation is UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means that although the allegation may have happened or is valid there is not a preponderance of the evidence to prove that the alleged violation occurred.

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

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023

LIC9099 (FAS) - (06/04)

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