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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700516
Report Date: 10/15/2024
Date Signed: 10/16/2024 08:30:34 AM

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
07/30/2024 and conducted by Evaluator Albert Johnson
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240730145630
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:
10/15/2024
UNANNOUNCEDTIME BEGAN:
10:04 AM
MET WITH:LockwoodTIME COMPLETED:
12:05 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff hit resident in the face
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
This is a repeat of an allegation that was substantiated on 9/17/2024.

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. The plan of correction was completed by the facility on 9/18/2024. Therefore, there will not be a 9099D page.
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2024
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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