157209316-10-28-2025-24-AS-AWAN-DT8VD8-20260417162018

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157209316
Report Date: 10/21/2025
Date Signed: 10/28/2025 09:53:59 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/13/2025 and conducted by Evaluator Lisa Salazar

COMPLAINT CONTROL NUMBER: 24-AS-20251013113355

FACILITY NAME:	TRINITY, THE		FACILITY NUMBER:	157209316
ADMINISTRATOR:	LAZAGA, JETHRONEL		FACILITY TYPE:	740
ADDRESS:	200 TRINITY AVE		TELEPHONE:	(661) 563-1761
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93307
CAPACITY:	10	CENSUS: 10	DATE:	10/21/2025
		UNANNOUNCED	TIME BEGAN:	01:12 PM
MET WITH:	Jethronel Lazaga, Administrator		TIME COMPLETED:	03:49 PM

ALLEGATION(S):

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8
9

Staff did not ensure consumables provided to resident were free from contamination.

INVESTIGATION FINDINGS:

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13

On 10/21/25, Licensing Program Analysts (LPAs) L. Salazar and S. Doucette arrived to the facility unannounced to conduct the required 10-day site inspection. LPAs were greeted by staff, stated the purpose of the visit and were allowed entry. Administrator arrived to the facility shortly after.

Based on LPAs observations and interviews conducted, Resident R1's lemondade had 4 small mold spores. The preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division & Chapter 8, is being cited on the attached LIC 9099D. If not corrected, the violation will have a potential risk to the health, safety, or personal rights of clients in care.

An exit interview was conducted with Administrator. A plan of correction was developed by Administrator and reviewed with LPA. A copy of this report and appeal rights were discussed and provided at the time of visit.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/13/2025 and conducted by Evaluator Lisa Salazar

COMPLAINT CONTROL NUMBER: 24-AS-20251013113355

FACILITY NAME:	TRINITY, THE		FACILITY NUMBER:	157209316
ADMINISTRATOR:	LAZAGA, JETHRONEL		FACILITY TYPE:	740
ADDRESS:	200 TRINITY AVE		TELEPHONE:	(661) 563-1761
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93307
CAPACITY:	10	CENSUS: 10	DATE:	10/21/2025
		UNANNOUNCED	TIME BEGAN:	01:12 PM
MET WITH:	Jethronel Lazaga, Administrator		TIME COMPLETED:	03:49 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff were unable to effectively communicate due to a language barrier.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025

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 3

Control Number 24-AS-20251013113355

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: TRINITY, THE	FACILITY NUMBER: 157209316
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/21/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/31/2025 Section Cited CCR 87555(b)(23)	1 2 3 4 5 6 7	87555 General Food Service Requirements (b) The following food service requirements shall apply: (23) All readily perishable foods or beverages capable of supporting rapid and progressive growth of micro-organisms which can cause food infections or food intoxications shall be stored in covered containers at appropriate temperatures.	1 2 3 4 5 6 7	Administrator will send proof that all staff have been made aware and agreed to change Resident R1's drinks 3 times a day.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by LPA's observation and interviews that Resident R1's lemonade, at R1's beside, to have 4 small mold spores in it. If not corrected, the violation will have a potential risk to the health, safety, or personal rights of clients in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Brenda Chan
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025

LIC9099 (FAS) - (06/04)

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