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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700516
Report Date: 10/01/2024
Date Signed: 10/02/2024 02:35:41 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
07/24/2024 and conducted by Evaluator Albert Johnson
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240724085427
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:
10/01/2024
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:C. LockwoodTIME COMPLETED:
03:13 PM
ALLEGATION(S):
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Staff mishandled a client
Staff are operating out of ratio
INVESTIGATION FINDINGS:
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On 10/1/2024, LPA Johnson arrived unannounced to deliver finding for the above allegations.

Allegation: Staff mishandled a client. Based on video evidence the facility locked R1 out of the home. The video shows R1 attempting to open the door, R1 pulls at the door and has no success opening the door and then walks back to the chairs on the front porch. The video then shows a staff member removing a latch as an unidentified female leaves the facility through the front door at that time R1 is allowed back into the facility. This is a personal rights violation.

Continued
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024
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 5
Control Number 27-AS-20240724085427
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: 10/01/2024
NARRATIVE
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Allegation: Staff are operating out of ratio. Based on information obtained in this investigation the facility did operate out of ratio on 7/18/2024, the facility had an incident on 7/18/24, on the night shift. R2 was aggressive with a female staff who was working alone on that evening. R2 assaulted S1 and S1 had no support to redirect R2's assault. The facility had two staff assigned to work that evening but the other staff went home. The facility was out of compliance with Regional Center requirements as well as their own program design. The facility staff should be trained in the importance of maintaining staffing ratios for the safety of residents and staff.

The allegation are substantiated.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
07/24/2024 and conducted by Evaluator Albert Johnson
COMPLAINT CONTROL NUMBER: 27-AS-20240724085427

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: DATE:
10/01/2024
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:TIME COMPLETED:
03:13 PM
ALLEGATION(S):
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Staff used medication as a sleeping aid
Staff mishandled the clients medication
Staff do not have adequate record keeping
Staff are sleeping during their shift resulting in the clients to be unattended
INVESTIGATION FINDINGS:
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Allegation: Staff used medication as a sleeping aid. Based on records reviewed, inspection of medications and interviews conducted the facility is using the medication prescribed by the primary care physician's for each resident as intended. Some of the residents have medication that assist with sleeping. All staff interviewed denied participating in using medication to make residents go to sleep. There is no record of outside medication that would be used to assist residents in going to sleep.

Allegation: Staff mishandled the clients medication. All staff interviewed denied using medication for anything other than what it was prescribed for. The facility's medication administration record is current and up-to-date. The inspection of the medications and review of the medication records did not support the allegation. The department was unable to establish that the facility is mishandling clients medication.
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 27-AS-20240724085427
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: 10/01/2024
NARRATIVE
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Allegation: Staff do not have adequate record keeping. Records reviewed confirm that the staff is maintaining adequate records at this time. The facility did receive a citation for not following-up on after ER visits and missing documentation for assessing or tallying in March of 2024. The facility has provided training for staff and provided the department with the required information to correct the deficiency. The department was unable to re-establish that the record keeping in not adequate.

Allegation: Staff are sleeping during their shift resulting in the clients to be unattended. Based on records reviewed and interviews conducted the facility is self monitoring the graveyard shift with pop-in visits on various evening. All staff and clients interviewed denied witnessing staff sleeping on their shift.

Based on interviews and record reviews, the Department has determined that there is not a preponderance of evidence. Therefore, these allegations are UNSUBSTANTIATED.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20240724085427
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: 10/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/16/2024
Section Cited
CCR
80072(a)(1)
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80072 Personal Rights
(a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following:(1) To be accorded dignity in his/her personal relationships with staff and other persons.
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Licensee/Administrator will submit to LPA a statement of understanding regarding Personal Rights regulation 80072 and its requirements. Administrator will also conduct an in-service training for staff regarding understanding of personal rights for client care. The licensee/administrator will send a sign-in sheet with all staff signatures by POC due date 10/16/2024.
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This requirement was not met as evidenced by video support. R1 was locked out of the facility and let back in after an unidentified person left.
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Type B
10/16/2024
Section Cited
CCR
85065.6
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85065.6 Night Supervision(g) In facilities providing care to Regional Center clients who rely upon others to perform all activities of daily living, night supervision shall be maintained as required by the Regional Center, but no less than the staff-client ratio specified in Sections 85065.6(f) and (f)(1).
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Licensee/Administrator will submit to LPA a statement of understanding regarding staffing and ratios.
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This requirement is not met as evidenced by interviews conducted and declariations submitted. There was one staff working with four residents on the night of 7/18/2024
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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: 10/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5