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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 455002607
Report Date: 06/28/2022
Date Signed: 06/29/2022 01:27:40 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/25/2022 and conducted by Evaluator Misty Valencia
COMPLAINT CONTROL NUMBER: 25-AS-20220525151346
FACILITY NAME:COLLYER HOMEFACILITY NUMBER:
455002607
ADMINISTRATOR:VICTORINE, CHAYLENEFACILITY TYPE:
735
ADDRESS:699 COLLYER DRTELEPHONE:
(530) 244-7513
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY:4CENSUS: 3DATE:
06/28/2022
UNANNOUNCEDTIME BEGAN:
01:24 PM
MET WITH:Chaylene Victorine, Administrator. TIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Administrator is not competent to provide the services necessary to meet individual client needs.
Facility does not keep on the premises a supply of staple nonperishable foods for one week and/or fresh perishable foods for two days.
Facility vehicle used for transporting residents is in disrepair.
Administrator using money for illegal activities.
INVESTIGATION FINDINGS:
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on 06/28/2022, Licensing Program Analyst (LPA) Misty Valencia conducted an unannounced complaint investigation visit to deliver findings regarding the above allegations and met with Chaylene Victorine, Administrator.

Prior to initiating the complaint visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; contacted Administrator and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Masks. Additionally Admin screen LPA at front door.

continued on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Misty Valencia
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022
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 25-AS-20220525151346
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: COLLYER HOME
FACILITY NUMBER: 455002607
VISIT DATE: 06/28/2022
NARRATIVE
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-Administrator is not competent to provide the services necessary to meet individual client needs. -Administrator using money for illegal activities.-Facility does not keep on the premises a supply of staple nonperishable foods for one week and/or fresh perishable foods for two days. -Facility vehicle used for transporting residents is in disrepair.

The department investigated the above allegations and during interviews with Administrator (Admin), three of three (3/3) staff, four of four (4/4) clients, and records reviewed it was determined that above allegations are all un-substantiated.



Administrator is not competent to provide the services necessary to meet individual client needs. Administrator using money for illegal activities. Interviews concluded that all clients get their needs met with no issues or concerns. They get their personal items, bathed/showered, toileted, fed and activities done on a daily basis. Interviews concluded that the facility staff and clients have never witnessed or heard anything regarding Admin using money for illegal drugs. Staff and clients stated that the Admin has never showed any signs or appeared to be under the influence or acting that way.

Facility does not keep on the premises a supply of staple nonperishable foods for one week and/or fresh perishable foods for two days. Interviews concluded that there are no concerns with lack of food in the facility. 3/3 staff reported that the Admin goes food shopping at least once a week. 4/4 residents reported that they get breakfast, lunch dinner, and snacks everyday with no concerns. Both staff and clients interviewed reported that there are always fresh fruit available and plenty of food in the refrigerator/freezer for them and staff has never used their own money to purchase food.

Facility vehicle used for transporting residents is in disrepair. Interviews concluded that the facility vehicle has had a history of breaking down, but they always get to where they need to go. There is also a bus stop less than a quarter ΒΌ of a mile from the facility for those clients who are independent. Staff reported that they are all insured and may provided transportation in their personal vehicle if needed with no hesitation.

The preponderance of evidence standard has not been met. The allegations are Unsubstantiated.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted and report emailed to Administrator.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Misty Valencia
LICENSING EVALUATOR SIGNATURE:

DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2