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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 483010050
Report Date: 06/25/2025
Date Signed: 06/25/2025 06:34:15 PM

Substantiated


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
04/18/2025 and conducted by Evaluator Elpidia Hernandez Torres
COMPLAINT CONTROL NUMBER: 01-CC-20250418140946
FACILITY NAME:PAYNE, JESSICA FCCHFACILITY NUMBER:
483010050
ADMINISTRATOR:PAYNE, JESSICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 655-6210
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY:14CENSUS: 4DATE:
06/25/2025
UNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:Licensee Jessica PayneTIME COMPLETED:
06:45 PM
ALLEGATION(S):
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Licensee allows uncleared adult to provide care and supervision
Licensee does not ensure facility is clean and orderly
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Elpidia Hernandez Torres, conducted a subsequent complaint investigation inspection on 06/25/25 for the purpose of delivering the findings regarding the above allegations. The four children present are licensee's children not day care children. LPA previously met with Licensee on 05/06/25 to discuss the purpose of the visit and request personnel records and children roster. It was alleged that Licensee allows uncleared adult to provide care and supervision, and Licensee does not ensure facility is clean and orderly.

During the course of the investigation, interviews were conducted with licensee, two guardians and two previous assistants between 04/25/25- 06/16/2025. Licensee reported she had three adults (A1-A3) who worked with her and all were cleared. Licensee reported she confirmed staff were cleared when she emailed the regional office on February 2025. Licensee also reported she had paid for both A1 and A2 to go get fingerprinted and receive background clearance. Licensee reported she couldn’t remember when the last time one of her assistants (A1) worked in the home, and that her other assistant (A2) had worked at least one day in April, as A2 was a no show on a 2nd date. Licensee also reported if the home was messy it was due to the children playing and due to the licensee removing furniture as she was in the process of re-locating
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2025
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 6
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
04/18/2025 and conducted by Evaluator Elpidia Hernandez Torres
COMPLAINT CONTROL NUMBER: 01-CC-20250418140946

FACILITY NAME:PAYNE, JESSICA FCCHFACILITY NUMBER:
483010050
ADMINISTRATOR:PAYNE, JESSICAFACILITY TYPE:
810
ADDRESS:1500 GARFIELD STREETTELEPHONE:
(707) 655-6210
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY:0CENSUS: 4DATE:
06/25/2025
UNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:Licensee Jessica PayneTIME COMPLETED:
06:45 PM
ALLEGATION(S):
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Day care children do not receive adequate meals while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Elpidia Hernandez Torres conducted a subsequent complaint investigation visit with licensee for the purpose of delivering complaint investigation findings. The four children present are licensee's children not day care children. It has been alleged day care children do not receive adequate meals while in care.

During the course of the investigation, interviews were conducted with licensee, two guardians and two previous assistants between 04/25/25- 06/16/2025. Licensee reported she would provide meals for the day care children, but sometimes guardians would provide meals for their own children. One assistant A1, reported the licensee would provide meals for the children but they would cook meals as well.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 01-CC-20250418140946
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: 06/25/2025
NARRATIVE
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Guardian interviews revealed guardians would take food for their children. One guardian reported they would take meals for their children, because the children would tell the guardian they were still hungry. Even though licensee sent pictures to guardian of the meals licensee provided. Another guardian reported they would provide meals for their children because their children didn’t like the meals licensee provided. Guardian also reported, even though they provided meals for their children, they didn’t feel confident licensee was heating the food when required or offering the food guardian provided to the children.

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.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 01-CC-20250418140946
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: 06/25/2025
NARRATIVE
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Guardians reported they had observed licensee and additional adults as her assistants providing care and supervision over their children. Both guardians corroborated A1 was an assistant providing care and supervision at least two days. One guardian reported licensee told them, A1 was going to be working at the daycare and that A1 was cleared. Another guardian reported licensee had told them A1 was helping in the daycare. Both guardian’s interviews revealed there were other assistants but weren’t able to identify A2, by name. Guardians reported the home was not clean and orderly, reporting the home was cluttered and dis-organized.

LPA reviewed the facility roster of cleared adults able to provide care and supervision or reside in the home with the licensee. A1 was not listed on the roster, A2 was on the roster in “pending status” indicating A2 began the background process but was not completed. A1 and A2 didn’t background clearance to work or reside in the home. A1 was interviewed, and reported they only worked a few times in the day care, and were not aware they did not have background clearance. LPA received evidence of the day care area looking cluttered with toys scattered on the floor and toys stacked in bins, and the walls of the day care room with a black residue on them at the eye level of preschool aged children.

Therefore, the preponderance of evidence standard has been met and the above allegations are found to be substantiated. The California Code of Regulations, Title 22, Division 12 & Chapter 1, sections 102370(d)(2) and 102417(b) are being cited on attached LIC 9099D.

A civil penalty of $300 is being issued. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. Exit interview conducted and report was reviewed with licensee. LPA Elpidia Hernandez Torres informed licensee that this report dated 06/25/25 document(s) one Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. LPA also informed licensee to provide a copy of this licensing report dated 06/25/25 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 01-CC-20250418140946
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/25/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/26/2025
Section Cited
CCR
102370(d)(2)
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102370 Criminal Record Clearance (d) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working...(1) Obtain a California clearance.

This was not met as evidence by...
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The licensee reported she currently does not have an active license as she is in the re-location process. Moving forward when hiring any assistant licensee will ensure the employee has gotten fingerprinted and called the regional office before the employee begins to work at the day care.
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A1 and A2 did not have back ground clearance. This poses an immediate health and safety risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 01-CC-20250418140946
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/25/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
07/09/2025
Section Cited
CCR
102417(b)
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102417 Operation of a Family Child Care Home (b) The home shall be kept clean and orderly, with heating and ventilation for safety and comfort. This was not met as evidence by...
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The licensee reported the home was clean and does not agree with the finding. The licensee currently does not have an active license but is clean and organized when she has a license. Licensee reported she has 7 kids of her own and cleans every night.
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based on evidence received and interviews conducted the day care area was messy and un-organized. This poses a potential health and safety risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6