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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880564
Report Date: 05/24/2024
Date Signed: 05/24/2024 12:57:50 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
05/23/2024 and conducted by Evaluator Magda Malcore
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240523123611

FACILITY NAME:PEYTON'S PLACE BEGONIAFACILITY NUMBER:
331880564
ADMINISTRATOR:CROW, PEYTON RANDALLFACILITY TYPE:
735
ADDRESS:35230 BEGONIA LNTELEPHONE:
(951) 257-4193
CITY:WINCHESTERSTATE: CAZIP CODE:
92596
CAPACITY:4CENSUS: 4DATE:
05/24/2024
UNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Chris Warner - AdministratorTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff are using closets as bedrooms
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced visit to initiate a complaint investigation. LPA met with Chris Warner, Administrator, and discussed the purpose of the visit.

Regarding allegation, staff are using closets as bedrooms, LPA inspected (4) client bedrooms and one (1) staff bedroom. LPA observed in the staff's bedroom closet, an inflated mattress with bed linen, a pillow, and snacks. Administrator Warner stated that the inflatable mattress is used by staff for resting but deflated and stored away.
Based on LPA observations and interviews, the allegation is Substantiated.
A finding that the complaint is Substantiated means that the allegation(s) is valid because the preponderance of the evidence standard has been met.
An exit interview was conducted where reports (LIC9099&LIC9099-D) were discussed and provided with appeal rights to Administrator Warner at the conclusion of the visit.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024
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 3
Control Number 56-AS-20240523123611
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: PEYTON'S PLACE BEGONIA
FACILITY NUMBER: 331880564
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
05/31/2024
Section Cited
CCR
85087(a)(3)(A)
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(a) In addition to Section 80087, bedrooms must meet, at a minimum, the following requirements: (3) No room commonly used for other purposes shall be used as a bedroom for any person. (A)Such rooms shall include but not be limited to halls, stairways,...garages, storage areas, and sheds...This requirement is not met as evidenced by:
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The Administrator removed the mattress and stored away the bed linen. No futher action is required.
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Based on LPA observations and interviews, the licensee did not comply with the section cited above by LPA observed in the staff's bedroom closet, an inflated mattress with bed linen, a pillow, and snacks; which poses/posed a a potential health, safety or personal rights risk to persons 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: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3