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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880573
Report Date: 09/24/2024
Date Signed: 09/24/2024 10:58:08 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
05/23/2024 and conducted by Evaluator Mary Rico
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240523135034
FACILITY NAME:PEYTON'S PLACE HARVARDFACILITY NUMBER:
331880573
ADMINISTRATOR:CROW, PEYTON RANDALLFACILITY TYPE:
735
ADDRESS:36069 HARVARD CTTELEPHONE:
(951) 208-7309
CITY:WINCHESTERSTATE: CAZIP CODE:
92596
CAPACITY:4CENSUS: 4DATE:
09/24/2024
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Chris Warner TIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Staff are mistreating the clients while in care.
Staff are falsifying documents.
Facility does not provide appropriate staffing to meet residents' needs.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Mary Rico and Raquel Hernandez conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Administrator Chris Warner and explained the purpose of the visit. The investigation consisted of staff interviews, client interviews and record review.

For the allegation, Staff are mistreating the clients while in care.

LPA Rico conducted 2 client interviews and 4 staff interviews. During staff interviews 4 out of the 4 staff stated they are not mistreating their clients while in care. During client interviews, 2 out of the 2 clients stated they’re not being mistreated.

For the allegation, staff are falsifying documents.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 56-AS-20240523135034
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: 09/24/2024
NARRATIVE
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During staff interviews 4 out of the 4 staff stated they are not falsifying documents. 4 out of the 4 staff also stated they have not witnessed a team member falsify their documents.

During record review, LPA reviews staff files and resident’s records. 4 out of the 4 staff confirm their signatures on facility files.

For the allegation, Facility does not provide appropriate staffing to meet residents' needs.

During staff interviews, 4 out of the 4 staff stated they have enough staff to meet residents’ needs. During client interviews, LPA Rico did not find evidence to corroborate the allegation.

In addition, during facility tour LPA observed 3 staff working the morning shift on May 30, 2024. LPA observed enough staff based on facility’s LIC500.

Based on evidence obtained during the investigation, the allegation listed above is deemed UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation 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 Administrator Chris Warner.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024
LIC9099 (FAS) - (06/04)
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