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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 455002046
Report Date: 10/02/2025
Date Signed: 10/02/2025 02:23:39 PM

Substantiated


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
09/26/2025 and conducted by Evaluator Sarah Benson
COMPLAINT CONTROL NUMBER: 59-AS-20250926155408
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: DATE:
10/02/2025
UNANNOUNCEDTIME BEGAN:
01:23 PM
MET WITH:Administrator Kaleb BranscombTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility staff mismanaged residents’ money.
INVESTIGATION FINDINGS:
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On 10/02/2025 at 1:20PM Licensing Program Analyst (LPA) Sarah Benson conducted an unannounced visit to open a complaint. LPA Benson met with Administrator Kaleb Branscomb.

During today's visit the facility was toured, records were reviewed. LPA interviewed 1 staff. LPA requested the following documents during the visit: staff list with telephone numbers, staff schedule, client admission agreement, IPP and personal cash ledgers.

Continued on 9099-C, 9099-D.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sarah Benson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2025
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 59-AS-20250926155408
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: 10/02/2025
NARRATIVE
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Facility staff mismanaged residents’ money.

It was reported that staff used the residents’ money to buy smart water and sunflower seeds.

Staff reported yes, there was a lot going on with the residents at the store and I paid for the resident’s items and mine all at once.

Based on the evidence obtained, the preponderance of evidence standard has been met; therefore, the allegation is found to be Substantiated. California Code of Regulations (Title 22) is being cited on the attached LIC 9099D. Appeal rights are provided, and a closure interview was conducted.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sarah Benson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 59-AS-20250926155408
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/02/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/02/2025
Section Cited
CCR
80026(e)
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Safeguards for Cash Resources, Personal Property, and Valuables of Residents. Cash resources, personal property, and valuables of clients shall be separate and intact, and shall not be commingled with facility funds or petty cash.
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Administrator will pay back money owed.
Administrator will have a training for proper use of client funds.
Administrator will ask for assistance with clients when needed.
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The residents cash resource was not kept separate and intact. This poses a potential health and safety risk to residents 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: Lauren Crocker
LICENSING EVALUATOR NAME: Sarah Benson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3