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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700516
Report Date: 08/20/2024
Date Signed: 08/26/2024 11:46:21 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
05/22/2024 and conducted by Evaluator Albert Johnson
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240522152021

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:
08/20/2024
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:William BonnerTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Staff transported resident to cannabis dispensary
Staff did not prevent resident(s) from engaging in inappropriate behaviors.
INVESTIGATION FINDINGS:
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Allegation: Staff transported resident to cannabis dispensary. Residents interviewed confirmed that a staff member did transport them to the dispensary and also to his girlfriends apartment. The residents stated that the staff member is no longer working at the facility. The residents stated that the staff would take them on trips to the store to buy items for the house and sometimes they would go to other places including the girlfriends apartment and to the dispensary. The residents stated that the staff would not buy them anything from the "weed store", Resident stated that we would stay in the car and wait until the staff would come back. Residents confirmed that staff would buy them a soda or other items from the regular stores.

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

DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 27-AS-20240522152021
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: 08/20/2024
NARRATIVE
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Allegation: Staff did not prevent resident(s) from engaging in inappropriate behaviors.
Residents interviewed confirm that they play their music "so they can hear it." The residents state that they have things to do and staff try to get them to do something's but they would rather listen to music and play their games or sit outside watching the neighbors.

Staff interviewed confirm that the residents are reminded to keep the music down and to be mindful of the neighbors. Staff stated that most times the residents want to be left alone and they will go to their room and shut the door or go outside and sit on the porch.

The facility does have intervention plans for each resident, however, the plans are not being followed by the staff and as a result the residents are engaging in inappropriate activities including playing their music loud and not providing replacement behaviors for residents disturbing the peace.

The residents in care have histories of drug abuse, personal relationship issues and lack of supervision. Staff providing care should follow care plans to keep the resident engaged and free from inappropriate activities that may be triggers for behaviors.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 27-AS-20240522152021
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: 08/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/03/2024
Section Cited
CCR
85068.2(H)(2)
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85068.2 Needs and Services Plan (H) The client's individual emergency intervention plan, required by Section 85168.2(a).
(2) Facility plans for providing services to meet the individual needs identified above.
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The licensee/Administrator will provided training for staff on intervention plans and will submit the training materials and sign-in sheet for all training's.
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This requirements is not met as evidenced by staff not following the plan or not knowing what the plan is to redirect residents having crisises. This is a potential safety risk to residents in care.
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This information will be submitted to the department by the POC date.
Type B
09/03/2024
Section Cited
CCR
85065(b)
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85065 Personnel Requirements (b) The licensee shall employ staff as necessary to ensure provision of care and supervision to meet client needs.
This requirement is not met as evidenced by interviews conducted
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The licensee/Administrator will provided training for staff on intervention plans and will submit the training materials and sign-in sheet for all training's.
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and records reviewed staff have engaged in activities that are not identified in the resident's care plan and may be triggers for other behaviors. This is a potential health and safety risk to residents
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This information will be submitted to the department by the POC date.
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: 08/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 6