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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 483010050
Report Date: 12/30/2024
Date Signed: 12/30/2024 04:58:38 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/01/2024 and conducted by Evaluator Elpidia Hernandez Torres
COMPLAINT CONTROL NUMBER: 01-CC-20241001110147
FACILITY NAME:PAYNE, JESSICA FCCHFACILITY NUMBER:
483010050
ADMINISTRATOR:PAYNE, JESSICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 655-6210
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY:14CENSUS: 10DATE:
12/30/2024
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Licensee Jessica PayneTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Facility operated over capacity
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Elpidia Hernandez Torres conducted a subsequent complaint investigation visit with licensee on 12/30/24 at 02:45PM for the purpose of delivering complaint investigation findings. LPA previously met with licensee on 10/10/2024 and 10/15/2024 to open the complaint and initiate the investigation. It has been alleged facility operated over capacity in August 2024.

During the investigation, interviews were conducted with licensee, licensee’s assistant, three children (C1-C3), and five guardians (G1-G5) between 10/10/24- 12/11/24. On 10/10/24, licensee reported she participates in the local resource and referral agency subsidy program, who notified licensee that she was overlapping in the number of children present between 03:00PM and 05:00PM during the month of August 2024 and that she had 10 days to terminate four families. Licensee reported to LPA, she was not aware of the overlapping, as she and her assistants count the number of children always present to ensure the facility is within ratio but that she rearranged the children’s schedules so there wouldn’t be overlapping. Licensee stated she does not have written schedules with the families but does have a verbal agreement.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2024
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 01-CC-20241001110147
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: PAYNE, JESSICA FCCH
FACILITY NUMBER: 483010050
VISIT DATE: 12/30/2024
NARRATIVE
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Assistant reported when she arrives at 10:00 am, there are 2-4 children present, and licensee will leave throughout the day to conduct pickups and drop offs but will take children with her so assistant isn’t left alone out of ratio. Assistant further stated that upon Licensee’s return around 4:30 PM, Licensee has between five or six children, and she typically has four to six children.

Children interviews disclosed there are usually about 7 kids present including licensee’s own children, but there have been times when there’s been 12 or 10 children present with the licensee and assistant present. One child reported they heard the licensee count 15 or 16 children out loud and that is how licensee will ask children to go with her to conduct transportation services. Some guardians reported they don’t count the number of children present when they arrive to pick up their children while others reported there are only a few day care children present when they arrive to drop off their children.

When LPA was present in the facility on 10/10/24, and 10/15/24, licensee was within ratio and not operating over capacity. The local resource and referral agency subsidy program receives sign in/ out sheets that only pertain to families who participate in the program and are turned in throughout the month. On 11/21/24 this agency had a portion of the sign in/out sheets available for the month of October. Based on the sign/in out sheets from 10/10/24 and 10/15/24, the number of children present did not accurately represent the children present that LPA observed while present in the facility.

Based on interviews conducted and records reviewed, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, therefore the allegation is Unsubstantiated. This report was reviewed and discussed with licensee who was provided a copy of this CIR and Appeal Rights. All licensing reports are public information and must be made available upon request for at least three years.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2