331880742-3-14-2026-18-AS-RORN-DSFPNU-20260323112830

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880742
Report Date: 03/14/2026
Date Signed: 03/14/2026 12:02:11 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
08/14/2023 and conducted by Evaluator Tena Herrera

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20230814163719

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):

1
2
3
4
5
6
7
8
9

Staff do not safeguard resident's personal items
Staff did not provide transportation as agreed

INVESTIGATION FINDINGS:

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

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 8/15/23 LPA Mixson conducted the initial 10-day visit, interviewed the facility Administrator and toured the facility. 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)

Page: 1 of 2

Control Number 18-AS-20230814163719

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

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The investigation revealed the following:
Allegation: Staff do not safeguard resident's personal items
It is alleged that clothes go missing after laundry day and the staff at the facility refuse to replace the missing items.. LPA interviewed 1 Client (C2) and they stated they stated that they do not have any clothes missing, they do have a cord for their PlayStation missing, however, during visit dated 3/14/26 LPA observed that cord had been found. LPA interviewed 3 staff and each denied the allegation stating that the clients clothing is washed separately to avoid any mix ups and clients clothing are tagged with their initials. LPA interviewed 5 witnesses 3 out of 5 stated that they have not observed or heard of clients items going missing at the facility.

Allegation: Staff did not provide transportation as agreed

It is alleged that staff refused to take C1 to work (night shift) because it was too late for them to assist with transportation. LPA interviewed 1 Client and they confirmed that transportation has never been an issue and staff assist with transportation when they visit family. LPA interviewed 3 staff and each denied the allegation, stating that clients are assisted with transportation when needed. Interviews with S1 and S2 revealed that there was one time that C1 picked up a late night shift and informed staff less than 2 hours before their shift started and due to the late notice they could not get staff coverage to assist with transportation. LPA interviewed 5 witnesses and 4 out of 5 witnesses denied the allegation and stated that they haven’t observed or heard of any issues with transportation at the facility.

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)

Page: 2 of 2