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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 330900784
Report Date: 10/27/2025
Date Signed: 10/27/2025 01:54:03 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO 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
09/16/2025 and conducted by Evaluator Raquel Hernandez
COMPLAINT CONTROL NUMBER: 56-AS-20250916094027
FACILITY NAME:PEPPERMINT RIDGEFACILITY NUMBER:
330900784
ADMINISTRATOR:STEPHANIE BARRONFACILITY TYPE:
735
ADDRESS:825 MAGNOLIATELEPHONE:
(951) 273-7320
CITY:CORONASTATE: CAZIP CODE:
92879
CAPACITY:12CENSUS: 8DATE:
10/27/2025
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Administrator Jessica PazTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Staff are verbally abusing resident
Staff do not provide adequate supervision to residents
Staff allows other residents to treat resident without dignity or respect
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Raquel Hernandez conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Administrator Jessica Paz and explained the purpose of the visit. The investigation consisted of client and staff interviews.

For the allegation, Staff are verbally abusing resident.

LPA conducted (5) client interviews. 5 out of the 5 clients stated staff do not verbally abuse them. LPA conducted (7) staff interviews. 7 out of the 7 stated they have not verbally abused any clients in care nor have witnessed clients in care being verbally abused by other facility staff.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2025
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 2
Control Number 56-AS-20250916094027
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: PEPPERMINT RIDGE
FACILITY NUMBER: 330900784
VISIT DATE: 10/27/2025
NARRATIVE
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For the allegation, Staff do not provide adequate supervision to residents.

LPA conducted (5) client interviews. 5 out of the 5 clients stated there are always facility staff at the facility to help them. LPA conducted (7) staff interviews. 7 out of the 7 staff stated facility staff do provide adequate supervision and there is always staff at the facility.

For the allegation, Staff allows other residents to treat resident without dignity or respect

LPA conducted (5) client interviews. Client #1 (C1) and Client #2 (C2) stated clients treat each other nicely. Client #3 (C3), Client #4 (C4), and Client #5 (C5) stated clients do treat each other with respect and dignity. LPA conducted (7) staff interviews. 7 out of the 7 staff stated all clients treat each other with respect and are redirected when behaviors occur within each other.

Based on the evidence gathered during today’s investigation, the allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

An exit interview was conducted and this report (LIC9099) and (LIC9099C) were discussed and provided to Administrator Jessica Paz.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2025
LIC9099 (FAS) - (06/04)
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