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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 315002935
Report Date: 05/06/2025
Date Signed: 05/06/2025 01:16:54 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
01/31/2025 and conducted by Evaluator Cheyenne Ratajczak
COMPLAINT CONTROL NUMBER: 59-AS-20250131151446
FACILITY NAME:TRINITY HOME FOR SENIORFACILITY NUMBER:
315002935
ADMINISTRATOR:CADORNA, JULIUSFACILITY TYPE:
740
ADDRESS:5405 SAGE CTTELEPHONE:
(916) 251-7689
CITY:ROCKLINSTATE: CAZIP CODE:
95765
CAPACITY:6CENSUS: 4DATE:
05/06/2025
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Helen CabreraTIME COMPLETED:
01:25 PM
ALLEGATION(S):
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Staff did not provide adequate supervision resulting in resident sustaining multiple falls.
INVESTIGATION FINDINGS:
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On 05/06/2025, Licensing Program Analyst (LPA) Cheyenne Ratajczak and Graham Gunby arrived at the facility unannounced to deliver final findings to a complaint Community Care Licensing (CCL) received on 01/31/2025. LPA met with Staff Helen Cabrera and explained the purpose of the visit.

During the course of the investigation, the Department conducted interviews and record review.
LPA conducted interviews and file reviews. Interview with staff and residents revealed that Resident #1 (R1) did not have any falls at the facility but would slide out of their chair and be on the ground. When R1 was on the ground, staff would assist R1 back into their chair. LPA conducted a file review of R1s file and did not observe any unusual incident reports (UIRs) regarding falls. Facility will utilize lift assistance when needed for residents. Based on the information obtained, there is insufficient evidence that staff did not provide adequate supervision resulting in resident sustaining multiple falls therefore the allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the findings are unsubstantiated.
Exit interview conducted and a copy of the report and appeal rights was left at the facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cheyenne Ratajczak
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
01/31/2025 and conducted by Evaluator Cheyenne Ratajczak
COMPLAINT CONTROL NUMBER: 59-AS-20250131151446

FACILITY NAME:TRINITY HOME FOR SENIORFACILITY NUMBER:
315002935
ADMINISTRATOR:CADORNA, JULIUSFACILITY TYPE:
740
ADDRESS:5405 SAGE CTTELEPHONE:
(916) 251-7689
CITY:ROCKLINSTATE: CAZIP CODE:
95765
CAPACITY:6CENSUS: 4DATE:
05/06/2025
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Helen CabreraTIME COMPLETED:
01:25 PM
ALLEGATION(S):
1
2
3
4
5
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8
9
Staff refused to assist resident in a timely manner.
Staff yells at resident.
INVESTIGATION FINDINGS:
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On 05/06/2025, Licensing Program Analyst (LPA) Cheyenne Ratajczak and Graham Gunby arrived at the facility unannounced to deliver final findings to a complaint Community Care Licensing (CCL) received on 01/31/2025. LPA met with Staff Helen Cabrera and explained the purpose of the visit.

During the course of the investigation, the Department conducted interviews and record review.

Please continue to LIC9099C..
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cheyenne Ratajczak
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025
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 59-AS-20250131151446
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: TRINITY HOME FOR SENIOR
FACILITY NUMBER: 315002935
VISIT DATE: 05/06/2025
NARRATIVE
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Allegations: Staff refused to assist resident in a timely manner.- Unfounded

Interview with staff revealed they would assist R1 almost as soon as they would ask. Interview with House Manager revealed that they were at the facility doing Administrator work and watched staff respond right away. After which R1 had told House Manager that staff take forever to respond. House Manager explained that they watched staff respond right away to R1s needs. Interview with Resident #2 (R2) and Resident #3 (R3) revealed that staff respond almost immediately when needed. Based on information obtained through interviews, the Department finds the allegation to be UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

Allegations: Staff yells at resident.- Unfounded

Department conducted interviews with staff and residents. The facility currently has two residents. Interview with resident revealed they have never heard staff yell at them or other residents in the home. Resident interviews further revealed when they did hear yelling in the facility it was from R1. R1 would tend to yell at staff. R2 stated that it got to a point where they intervened and said something to R1 for the way they were treating others in the facility. Based on information obtained through interviews, the Department finds the allegation to be UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

Exit interview conducted and a copy of the report was left at the facility.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cheyenne Ratajczak
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3