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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700516
Report Date: 12/02/2024
Date Signed: 12/02/2024 05:19:34 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
10/16/2024 and conducted by Evaluator Albert Johnson
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20241016160146
FACILITY NAME:DE TRIO HEALTH CAREFACILITY NUMBER:
392700516
ADMINISTRATOR:BONNER, WILLIAMFACILITY TYPE:
735
ADDRESS:905 W. MAGNOLIATELEPHONE:
(209) 475-8243
CITY:STOCKTONSTATE: CAZIP CODE:
95203
CAPACITY:4CENSUS: 4DATE:
12/02/2024
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:McgillTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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9
Staff locked a client out of the home
INVESTIGATION FINDINGS:
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On 12/2/2024, LPA Johnson Arrived to deliver findings.

Allegation: Staff locked a client out of the home

Based on review of the video provided as evidence R1 is seen outside of the facility on the front porch area the video continues with R1 attempting to open the screen door which is locked on several attempts. After two minutes the latch on the screen doors is lifted and R1 is let back into the facility and a person is seen walking out of the facility heading into the direction away from the facility.

The allegation is substantiated.
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2024
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 4
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
10/16/2024 and conducted by Evaluator Albert Johnson
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20241016160146

FACILITY NAME:DE TRIO HEALTH CAREFACILITY NUMBER:
392700516
ADMINISTRATOR:BONNER, WILLIAMFACILITY TYPE:
735
ADDRESS:905 W. MAGNOLIATELEPHONE:
(209) 475-8243
CITY:STOCKTONSTATE: CAZIP CODE:
95203
CAPACITY:4CENSUS: 4DATE:
12/02/2024
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Mc GillTIME COMPLETED:
03:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are verbally abusing a client
Staff are hitting a client
Staff are smoking on the premises
INVESTIGATION FINDINGS:
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12
13
Allegation: Staff are verbally abusing a client. Interviews with staff and residents did not provide evidence to support the allegation. Residents interviewed stated that other house mates yell and scream at the staff and hit themselves all through the night sometimes. All individuals interviewed denied witnessing verbal abuse or any other kind of abuse while working or living at the facility.

Allegation: Staff are hitting a client. Interviews with staff and residents did not provide evidence to support the allegation. Staff member confirmed that R2 stated to S1 that She didn't hit him. R2 was unsure how his eye was black and blue, R2 continued to say that he had to defend himself. No other staff or resident gave testimony or stated that Staff are hitting the residents.
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 27-AS-20241016160146
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: 12/02/2024
NARRATIVE
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Staff are smoking on the premises. Interviews with staff and residents did not provide evidence to support the allegation. All staff and residents denied smoking bongs or any other form of marijuana on the premise. Staff stated that some staff smoke cigarettes, however, no staff or resident give statement about the use of marijuana at or around the facility.

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

DATE: 12/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 27-AS-20241016160146
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: 12/02/2024
NARRATIVE
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3
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Licensee/Administrator submitted to LPA on 10/16/2024 a statement of understanding regarding Personal Rights regulation 80072 and its requirements. Administrator conducted an in-service training for staff regarding understanding of personal rights for client care.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4