<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700516
Report Date: 08/14/2024
Date Signed: 08/26/2024 11:44:41 AM

Document Has Been Signed on 08/26/2024 11:44 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 CAREFACILITY NUMBER:
392700516
ADMINISTRATOR/
DIRECTOR:		BONNER, WILLIAMFACILITY TYPE:
735
ADDRESS:905 W. MAGNOLIATELEPHONE:
(209) 639-5134
CITY:STOCKTONSTATE: CAZIP CODE:
95203
CAPACITY: 4CENSUS: 4DATE:
08/14/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:De Trio Administrative StaffTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
An Informal Conference was conducted via Microsoft Teams with representatives from Licensee including Administrator William Bonner Jr., Business Partner Royal Young, Denica Lane Operation Manager, Licensing Program Manager Lisa Rios, Licensing Program Analyst Albert Johnson and Regional Center Representative Katina Richison.

The purpose of the informal conference was to address the facility’s compliance concerns. The Department has concerns stemming from multiple complaints and serious allegations.

The licensee was told that this Informal Conference is a part of the Administrative Action process and that further citations may result in an elevation to a formal non-compliance conference that could then lead to referral to the Department's legal division for possible revocation of licensure.

Issues discussed during the meeting were:

• Personal Rights -
• Health related services – Medication Administration
• Staffing- Responsibility for care and supervision
• Client records –
• Needs and Services Plans – Intervention plans - Training

See 809-C for continuation of the office visit.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE: DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/14/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 08/14/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The facility has stated they will do the following to achieve continued and substantial compliance:

· Facility conducted/completed training for staff on 7/30/2024
(Medication administration, personal rights, behavior intervention training)
· Continue to hire additional staff to be able to meet the needs of the residents
· Conduct audit of care plans and pre-admission appraisals.

The facility will submit a calendar of activities for one month and a weekly activity schedule for each resident. The facility will also submit a 30 day assessment, IPP/behavior intervention plans for all residents in care. Please submit this information by the close of business on 8/21/2024.

The Department did notify the facility that a Case Management inspection will be conducted to ensure that the facility is within substantial compliance. LPA will be conducting this visit to ensure that the facilities operation is in compliance and assist the facility in establishing best practices.


Exit Interview. Copy of report provided.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2