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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336426839
Report Date: 02/11/2026
Date Signed: 02/11/2026 03:30:01 PM

Substantiated


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
01/09/2026 and conducted by Evaluator Raquel Hernandez
COMPLAINT CONTROL NUMBER: 56-AS-20260109134714
FACILITY NAME:PEACE AT HOMEFACILITY NUMBER:
336426839
ADMINISTRATOR:RUSH, JORDANFACILITY TYPE:
735
ADDRESS:7471 MAYFIELD STREETTELEPHONE:
(951) 432-7657
CITY:EASTVALESTATE: CAZIP CODE:
92880
CAPACITY:5CENSUS: 4DATE:
02/11/2026
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Administrator Jordan RushTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Licensee is not ensuring that personnel records accurately reflect the hours personnel actually worked.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Raquel Hernandez conducted an unnanounced visit to deliver findings for above allegations. LPA met with Administrator Jordan Rush and explained today's visit.

On 01/09/2026, the department received a complaint regarding personnel records not reflecting hours personnel actually worked. Upon visit on 01/14/2026, LPA observed (1) staff working with (4) clients in care. LPA reviewed staff schedule which indicated facility staff scheduled were (2). Based on record review and observations, the licensee did not ensure facility staff schedule accurately reflected staff working.

Based on the evidence gathered during today’s investigation, the allegation listed above are deemed SUBSTANTIATED. A finding that the complaints are SUBSTANTIATED means that the allegation are valid because the preponderance of evidence the standard has been met. During today’s visit, a deficiency was cited/issued per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) and (LIC9099D) was discussed and provided to Administrator Jordan Rush.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2026
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 3
Control Number 56-AS-20260109134714
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: PEACE AT HOME
FACILITY NUMBER: 336426839
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/11/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/11/2026
Section Cited
CCR
80066(f)
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80066 Personnel Records: (f) In all cases, personnel records shall document the hours actually worked.
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Licensee stated to understand regualtion and properly documenting personnel records and personnel hours worked.
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Based on record review and observations, the licensee did not comply with sectioned cited above by not ensuring personnel records accurately reflected hours worked, which poses an immediate health, safety, and 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: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
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
01/09/2026 and conducted by Evaluator Raquel Hernandez
COMPLAINT CONTROL NUMBER: 56-AS-20260109134714

FACILITY NAME:PEACE AT HOMEFACILITY NUMBER:
336426839
ADMINISTRATOR:RUSH, JORDANFACILITY TYPE:
735
ADDRESS:7471 MAYFIELD STREETTELEPHONE:
(951) 432-7657
CITY:EASTVALESTATE: CAZIP CODE:
92880
CAPACITY:5CENSUS: 4DATE:
02/11/2026
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Administrator Jordan RushTIME COMPLETED:
03:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Licensee is not adhering to ratio requirements.
INVESTIGATION FINDINGS:
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13
On 01/09/2026 the department received a complaint in regards to licensee not adhering to ratio requirements. LPA observed Individual Program Plans (IPPs) for clients in care which did not indicate a staff ratio requirement was needed for any clients in care.

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

An exit interview was conducted and this report (LIC9099A) along with other reports were discussed and provided to Administrator Jordan Rush.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3