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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602707
Report Date: 03/17/2025
Date Signed: 03/17/2025 04:22:17 PM

Document Has Been Signed on 03/17/2025 04:22 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:PEYTON'S PLACE SAN DIEGOFACILITY NUMBER:
374602707
ADMINISTRATOR/
DIRECTOR:		LANGWORTHY, VERONICAFACILITY TYPE:
735
ADDRESS:1973 GREY RABBIT HOLLOW LANETELEPHONE:
(760) 723-0882
CITY:FALLBROOKSTATE: CAZIP CODE:
92028
CAPACITY: 4CENSUS: 4DATE:
03/17/2025
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:20 PM
MET WITH:Licensee, Peyton CrowTIME VISIT/
INSPECTION COMPLETED:
04:25 PM
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On 3/17/2025, Licensing Program Analyst (LPA) Janette Romero conducted an unannounced health and safety visit in the facility. LPA was greeted and granted entry by Caregiver, Josue "David" Medrano who was informed of the purpose of the visit. Licensee, Peyton Crow arrived during the visit to meet with LPA and was also informed of the purpose of the visit.

LPA toured the facility with Licensee Crow, conducted interviews, and requested copies of pertinent records. The requested documentation will be provided to LPA by close of business on 3/18/2025. During today's visit, no immediate health or safety concerns were observed. An exit interview was conducted and a copy of this report was reviewed and provided to Licensee Crow.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE: DATE: 03/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/17/2025
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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