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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700516
Report Date: 09/17/2024
Date Signed: 09/17/2024 04:29:07 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/12/2024 and conducted by Evaluator Albert Johnson
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240612152623
FACILITY NAME:DE TRIO HEALTH CAREFACILITY NUMBER:
392700516
ADMINISTRATOR:BONNER, WILLIAMFACILITY TYPE:
735
ADDRESS:905 W. MAGNOLIATELEPHONE:
(209) 639-5134
CITY:STOCKTONSTATE: CAZIP CODE:
95203
CAPACITY:4CENSUS: 4DATE:
09/17/2024
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Staff McGillTIME COMPLETED:
03:25 PM
ALLEGATION(S):
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Staff are physically and verbally abusing residents in care.
INVESTIGATION FINDINGS:
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On 9/17/2024, LPA arrived at the facility unannounced to deliver findings for the allegation listed above.

During the course of investigation, LPA collected documents and conducted interviews. The department confirmed that an employee reported that R1 said S1 punched him in his eye on 7/18/24 during an incident involving S1 and R1 that was initially reported as aggressive act to staff from resident. S1 reported that R1 said he did not feel safe with S1. The employee believes R1 is intimidated by the Operations Manager and was afraid to be truthful. R1 was initially interviewed by Operations Manager Denica Layne on 7/19/24. R1's right eye was swollen and he had a dark bruise under his right eye. R1 refused to go to the hospital.
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024
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 3
Control Number 27-AS-20240612152623
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: DE TRIO HEALTH CARE
FACILITY NUMBER: 392700516
VISIT DATE: 09/17/2024
NARRATIVE
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When asked about the incident on 7/18/24, R1 stated that he beat up S1 because she was telling him to take his meds and he does not have to listen to her. When asked if S1 hit him, R1 continued to repeat that he beat up S1. When asked if S1 hit him back after he beat her up, R1 again repeated that he beat her up. R1 told the owners that he hit and kicked S1 and she hit him in his eye and beat him up giving him a black eye. De Trio Healthcare terminated the employment of S1 on 07/23/24."

The allegation is substantiated.

Exit interview conducted.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20240612152623
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: DE TRIO HEALTH CARE
FACILITY NUMBER: 392700516
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/18/2024
Section Cited
CCR
80065(a)
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80065 Personnel Requirements
(a) Facility personnel shall be competent to provide the services necessary to meet individual client needs and shall, at all times, be employed in numbers necessary to meet such needs.
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The facility has completed training on appropriate behavior interventions and de-escalation.
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This requirement is not met as evidenced by the actions of S1 during the incident with the outcome for R1 sustaining a black eye. This is a immediate safety risk to residents in care.
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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: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3