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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 455002046
Report Date: 08/27/2024
Date Signed: 08/27/2024 02:26:45 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/17/2024 and conducted by Evaluator Farhaan Sarangi
COMPLAINT CONTROL NUMBER: 59-AS-20240717164537
FACILITY NAME:PEREGRINE HOMEFACILITY NUMBER:
455002046
ADMINISTRATOR:BRANSCOMB, KALEBFACILITY TYPE:
735
ADDRESS:1163 PEREGRINE WAYTELEPHONE:
(530) 262-0967
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY:4CENSUS: 4DATE:
08/27/2024
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Direct Care Provider Tanya FranzkowiakTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Unexplained bruises, marks and scratches sustained on two clients
INVESTIGATION FINDINGS:
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On August 27, 2024, at approximately 01:45 PM, Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Peregrine Home for the purpose of delivering complaint findings. LPA was greeted at the door by Direct Care Provider Tanya Franzkowiak, and was granted access into the facility. Administrator arrived 20 minutes later.

During the course of the investigation, LPA reviewed client records, interviewed clients in care and staff. In addition, LPA made client observations on July 22, 2024.

Complaint alleges Unexplained bruises, marks and scratches sustained on two clients. Based on interviews conducted, LPA could not corroborate the allegation. During observations of facility clients, LPA observed 4 of 4 clients to be free from bruises, marks, and scratches. Furthermore, LPA received inconsistent statements from staff members. (Report continued on LIC 9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2024
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 59-AS-20240717164537
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: PEREGRINE HOME
FACILITY NUMBER: 455002046
VISIT DATE: 08/27/2024
NARRATIVE
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A finding that the complaint allegation of Unexplained bruises, marks and scratches sustained on two clients are unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview was conducted and a copy of this was report was signed and given to the Administrator.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2