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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392700516
Report Date: 01/03/2025
Date Signed: 01/03/2025 03:28:02 PM

Document Has Been Signed on 01/03/2025 03:28 PM - 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) 475-8243
CITY:STOCKTONSTATE: CAZIP CODE:
95203
CAPACITY: 4CENSUS: 4DATE:
01/03/2025
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:56 PM
MET WITH:L. McGillTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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LPA Albert Johnson made an unannounced POC visit to the facility to verify correction of citations issued during the Annual inspection on 11/15/2024 .

LPA toured the facility, reviewed document submitted for plans of correction observed that the deficiencies cited have been cleared.

Deficiencies cited under Title 22 Regulations have been cleared. Licensee complied with the terms of the POC by POC due date.

Facility was provided POC cleared letter.

LPA was informed about a staffing issues on or about 12/31/2024 regarding the 11 pm to 7 am shift . Operation manager had to come in on 1/1/2025 at 2:00 am to relieve a staff that had brought her infant child to work. The staff was terminated as a result. LPA has requested information related to the incident. The department will review the information and return at a later date to address the incident.

Exit interview conducted.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE: DATE: 01/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/03/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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