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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880564
Report Date: 03/19/2025
Date Signed: 03/19/2025 04:35:46 PM

Document Has Been Signed on 03/19/2025 04:35 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:PEYTON'S PLACE BEGONIAFACILITY NUMBER:
331880564
ADMINISTRATOR/
DIRECTOR:		CROW, PEYTON RANDALLFACILITY TYPE:
735
ADDRESS:35230 BEGONIA LNTELEPHONE:
(951) 257-4193
CITY:WINCHESTERSTATE: CAZIP CODE:
92596
CAPACITY: 4CENSUS: 3DATE:
03/19/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:00 PM
MET WITH:Staff Wilbert GomezTIME VISIT/
INSPECTION COMPLETED:
04:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Raquel Hernandez conducted an unannounced case management visit to the facility. LPA met with Staff Wilbert Gomez. LPA attempted to speak with Administrator Chris Warner but he is currently out of country. LPA spoke with Assistant Administrator Marchelino Roos over the phone and was granted that Staff Wilbert Gomez will be able to sign form.

The purpose of today's visit was to deliver an Immediate Exclusion letter for an individual named Christian Umana to the licensee. The exclusion of Christian Umana is based on a complaint of conduct inimical that has been substantiated.

LPA reviewed the exclusion letter with Assistant Administrator Marchelino Roos over the phone, explaining that Christian Umana is not allowed to be present in the facility. The licensee Marchelino Roos acknowledged understanding of this Immediate Exclusion and has agreed Christian Umana cannot be allowed to work in a CCL Licensed facility and/or have contact with residents in any facility licensed by the California Department of Social Services.

LPA verified that Christian Umana was not present at the facility during the visit. LPA was informed by Assistant Administrator that this person has not worked at the facility since 03/11/2025.

No deficiencies were cited during this visit. An exit interview was conducted where this report and Immediate Exclusion letter was discussed and provided to Assistant Administator Marchelino Roos.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/19/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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