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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197800850
Report Date: 03/16/2022
Date Signed: 03/16/2022 01:44:27 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/08/2022 and conducted by Evaluator Cynthia D Chan
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220308155604
FACILITY NAME:PAYNE CARE CENTERFACILITY NUMBER:
197800850
ADMINISTRATOR:WILLIAMS, LAVONIA PAYNEFACILITY TYPE:
735
ADDRESS:181 E. ARROW HIGHWAYTELEPHONE:
(909) 506-4428
CITY:CLAREMONTSTATE: CAZIP CODE:
91711
CAPACITY:4CENSUS: 4DATE:
03/16/2022
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Romelia Becerra, StaffTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Staff speaks inappropriately to client in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation on the allegation listed above. LPA arrived unannounced and met with Staff, Romelia Becerra. The reason for the visit was explained. Administrator, Lavonia Williams, arrived shortly thereafter to assist with the visit.

LPA Chan reviewed Staff files and obtained copies of documents pertaining to Client #1. LPA interviewed the Administrator, 5 Staff, 3 Clients, and attempted to interview client who is non-verbal but was not successful.

Regarding allegation - Staff speaks inappropriately to client in care. LPA interviewed the Administrator and 5 Staff, who all denied that Staff speaks inappropriately to clients in care. They stated they treat clients with respect and do not yell nor use profanity toward clients. They receive training often and are trained to de-escalate any situation with professionalism. They stated one of the clients (Client #1) would sometimes raise his/her voice at staff and when the staff tries to intervene and calm down the client, the client may interpret staff as yelling back. (Continue on LIC9099C)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2022
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 2
Control Number 28-AS-20220308155604
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: PAYNE CARE CENTER
FACILITY NUMBER: 197800850
VISIT DATE: 03/16/2022
NARRATIVE
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LPA reviewed the Individual Service Plan for Client #1 which addresses the verbal and aggressive behaviors that client is trying to reduce. The plan recommends for staff to speak quietly when behavior occurs so that Client #1 would model the voice. 2 out of the 3 clients interviewed stated that Staff do not yell or curse at them. They feel the staff treat them well and never heard any staff speaking inappropriately to others.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview was conducted with the Administrator. A copy of this report along with the appeal rights were provided.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2