331880573-10-24-2023-18-AS-EMAN-CX4SKG-20231030135643

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880573
Report Date: 10/24/2023
Date Signed: 10/24/2023 10:49:26 AM

Unsubstantiated

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
08/05/2021 and conducted by Evaluator Ryan Gardner

PUBLIC

COMPLAINT CONTROL NUMBER: 18-NP-20210805194750

FACILITY NAME:	PEYTON'S PLACE HARVARD		FACILITY NUMBER:	331880573
ADMINISTRATOR:	CROW, PEYTON RANDALL		FACILITY TYPE:	735
ADDRESS:	36069 HARVARD CT		TELEPHONE:	(951) 208-7309
CITY:	WINCHESTER	STATE:	ZIP CODE:	92596
CAPACITY:	4	CENSUS: 4	DATE:	10/24/2023
		UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Jessica Vega- Caregiver		TIME COMPLETED:	10:58 AM

ALLEGATION(S):

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Facility is mismanaging the clients medication.
Facility is not meeting the needs of the client.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ryan Gardner made an unannounced visit to deliver findings for the allegations listed above. LPA stated the purpose of the visit and was granted entry and met with Caregiver Jessica Vega. The investigation consisted of client interviews, staff interviews, and document review.

For allegation, Facility is mismanaging the clients medication:

Interviews with clients and the staff revealed that there are no issues with the facility staff mismanaging the client’s medications. Interviews revealed that the staff distributes the client’s medications according to the doctors’ orders. The staff denied mismanaging the client’s medications. The clients did not indicate their medications were being mismanaged. Document review of the client’s medication records (MARs) revealed that the facility is keeping records of when the clients receive a dose of medication. This includes the staff initialing the clients MARs records when the medication is given to the clients. Document review of the client’s physician’s order’s revealed that the medications prescribed by the doctor are the same medications listed in the clients MARs records.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 18-NP-20210805194750

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 HARVARD	FACILITY NUMBER: 331880573
	VISIT DATE: 10/24/2023

NARRATIVE

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For allegation, Facility is not meeting the needs of the client:

It was alleged that the facility staff is not taking the clients to their scheduled medical and dental appointments. Interviews with clients and the staff revealed that the facility staff take the clients to their medical and dental appointments. The staff denied not taking the clients to their medical and dental appointments. The clients did not indicate they had missed any medical or dental appointments. The only time a client might miss an appointment is when the client uses their personal right to refuse an appointment. When this occurs, the facility will reschedule the appointment for the client as soon as possible. Document review of the client’s records revealed that the facility keeps record of the dates of each medical and or dental appointment, the medical facility the of the appointment, the reason for the appointment, and if any new medication was prescribed to the client at the appointment.

Overall, there was not enough evidence to collaborate the allegations listed above.

Based on evidence obtained during the investigation, the two (2) allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report (LIC9099) was discussed and provided to Caregiver Jessica Vega, along with a copy of the appeal rights.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023

LIC9099 (FAS) - (06/04)

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