198601931-4-15-2025-28-AS-WSHO-DG2RDZ-20250424125643

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601931
Report Date: 04/15/2025
Date Signed: 04/15/2025 03:25:32 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
04/08/2025 and conducted by Evaluator Nune Margaryan

COMPLAINT CONTROL NUMBER: 28-AS-20250408094125

FACILITY NAME:	FLAGSHIP @ PAYSON		FACILITY NUMBER:	198601931
ADMINISTRATOR:	MAGEE, LORING		FACILITY TYPE:	735
ADDRESS:	18445 PAYSON ST		TELEPHONE:	(626) 331-2396
CITY:	AZUSA	STATE: CA	ZIP CODE:	91702
CAPACITY:	4	CENSUS: 4	DATE:	04/15/2025
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Loring Magee, Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff yelled at resident.
Staff did not treat resident with dignity and respect.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Nune Margaryan conducted a complaint visit to investigate the allegations listed above. LPA met with Administrator Loring Magee and explained the reason for the visit.

The investigation consisted of the following: LPA obtained copies of Staff & Client Rosters, copy of SIR dated 04/07/25, reviewed C1 file and collected relevant documents. Interviews conducted with Administrator,
Staff 1 (S1), Staff 2 (S2), Client 1 (C1) and Client 2 (C2). S1 and C1 were interviewed over the phone.

Continue 9099C

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025

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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Control Number 28-AS-20250408094125

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: FLAGSHIP @ PAYSON	FACILITY NUMBER: 198601931
	VISIT DATE: 04/15/2025

NARRATIVE

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In regard to the allegations Staff (S1) yelled at resident and Staff (S1) did not treat resident with dignity and respect. It was alleged that S1 yelled at C1 and spit, stuck out their tongue.

Interviewed Administrator and staff denied the allegation. They stated that staff never yelled at the client and treat them with dignity and respect. Interviewed clients indicated that staff did not yell at them and treat them with dignity and respect. Administrator stated that on 04/07/25 staff informed them that C1 was having a behavioral episode and yelling, screaming and lunging at S1. Also C1 called S1 "B" monkey and "Jerk". Incident report (SIR) dated 04/07/25 was provided to LPA. Interviewed S1 and S2 stated that C1 often yelled, scream because of C1's behavior. S1 stated that they never yelled at C1 or spit, stuck out their tongue. S2 stated S1 or other staff never spit, stuck out their tongue. Incident also was investigated by SGPRC and was unsubstantiated. Interviewed C2 stated that S1 is very nice and helpful. S1 always check on them and other clients. S1 or other staff never yelled at the clients and always respectful. C2 did not witness that S1 spit or stuck out tongue on C1 or others. C2 mentioned that C1 always yells and screams at the staff. C2 stated that it happened a week ago when C2 heard from their room how C1 was yelling at the staff. Interviewed C1 stated that staff is nice most of the time. C1 did not give any details regarding the incident that happened on 04/07/25. C1 stated that they feel ok, and everything is fine. Doesn't have any complaints about the staff. LPA reviewed C1 file and observed that C1 had a behavior of making false allegations. On the Behavioral Assessment report shows that C1 will falsify stories regarding the staff, stating they are yelling at the client when in fact that has not occurred.

Based on record review and interviews conducted the findings indicate, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.

An exit interview conducted, and a copy of this report was provided to Administrator.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Nune Margaryan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025

LIC9099 (FAS) - (06/04)

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