331880742-3-14-2026-18-AS-RORN-DSALHW-20260318084702

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880742
Report Date: 03/14/2026
Date Signed: 03/14/2026 12:01:50 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/21/2023 and conducted by Evaluator Tena Herrera

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20230421133319

FACILITY NAME:	A HOME 4 WAYNE, INC.		FACILITY NUMBER:	331880742
ADMINISTRATOR:	WATSON, PAMELA		FACILITY TYPE:	735
ADDRESS:	621 GROVESIDE DR		TELEPHONE:	(951) 219-2467
CITY:	SAN JACINTO	STATE: CA	ZIP CODE:	92582
CAPACITY:	6	CENSUS: 2	DATE:	03/14/2026
		UNANNOUNCED	TIME BEGAN:	11:39 AM
MET WITH:	Henry Campos – Caregiver		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Staff do not allow resident to go on outings with their family member(s).
Staff are not allowing resident to use their cellphone.
Staff do not respond to family members' requests for communication about resident in a timely manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Tena Herrera conducted an unannounced subsequent complaint visit to deliver findings on the reported allegations. LPA met with Henry Campos and explained the purpose of the visit.

The investigation consisted of the following:
On 4/28/23 LPA Delgado conducted the initial 10-day visit and interviewed 2 Staff, 1 Client and requested and obtained copies of pertinent documentation. On 3/9/26 LPA Herrera conducted subsequent visit, interviewed 2 Staff (S1-S2), 3 Witnesses (W1-W3), 1 Client (C2), and toured client bedrooms. C1 is no longer a client at this facility, therefore, no interview can be conducted. On 3/10/26 LPA Herrera interviewed 1 Staff and 2 Witnesses via phone calls. During todays visit 3/14/26 LPA Herrera delivered findings on the reported allegations.
(Continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2026

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 18-AS-20230421133319

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: A HOME 4 WAYNE, INC.	FACILITY NUMBER: 331880742
	VISIT DATE: 03/14/2026

NARRATIVE

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The investigation revealed the following:
Allegation: Staff do not allow resident to go on outings with their family member(s).
It is alleged that staff are not allowing clients to go on outings, saying they must talk to Pam for approval, and when family try to get ahold of Pam there is no response. LPA interviewed 3 staff and each denied the allegation stating that there have never been any issues with allowing clients to go on visits with family or their responsible parties. LPA interviewed 1 Client and they denied the allegation and stated they have never had issues visiting family or need to ask for permission to go on visits. LPA interviewed 5 witnesses and each denied the allegation and stated they have not heard of or witnessed this being an issue for the clients in care.

Allegation: Staff are not allowing resident to use their cellphone.

It is alleged that staff have also taken C1’s cell phone away and won't allow them to use it. LPA interviewed 1 Client and client stated that they don’t have a cell phone and have never had any issues making personal calls with the facility phone. LPA interviewed 3 staff and each denied the allegation, stated clients do not have cell phones and that clients are allowed to use the facility phone freely to make personal calls. LPA interviewed 5 witnesses and 4 out of 5 witnessed denied the allegation and stated they have never heard of this being an issue for the clients in care.

Allegation: Staff do not respond to family members' requests for communication about resident in a timely manner.

It is alleged that staff are not communicating with family and responsible parties in a timely manner. LPA interviewed 3 staff and each denied the allegation stating that family/responsible parties are notified of any important details regarding the clients. LPA interviewed 1 Client and they denied the allegation stating that their family communicates with staff regularly. LPA interviewed 5 witnesses and 3 out of 5 witnesses denied the allegation and stated they have never had an issue with communication with the facility staff regarding the clients in care.

Based on statements and interviews conducted with staff, clients, and witnesses, there was not enough supportive evidence to concur with the reported allegations. 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. Exit interview held, and a copy of this report was provided.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2026

LIC9099 (FAS) - (06/04)

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