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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 335530186
Report Date: 09/22/2025
Date Signed: 09/22/2025 02:12:12 PM

Unsubstantiated


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
09/16/2025 and conducted by Evaluator Raquel Hernandez
COMPLAINT CONTROL NUMBER: 56-AS-20250916084407
FACILITY NAME:PEPPERMINT RIDGEFACILITY NUMBER:
335530186
ADMINISTRATOR:BARRON, STEPHANIEFACILITY TYPE:
740
ADDRESS:648 LOCUST STTELEPHONE:
(951) 273-7320
CITY:CORONASTATE: CAZIP CODE:
92879
CAPACITY:4CENSUS: 4DATE:
09/22/2025
UNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Administrator Jessica PazTIME COMPLETED:
02:20 PM
ALLEGATION(S):
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Staff is verbally abusing residents.
Staff are mismanaging resident's medications.
Staff are not meeting resident's medical needs.
Staff are not providing adequate supervision.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Raquel Hernandez conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Administrator Jessica Paz and explained the purpose of the visit. The investigation consisted of resident and staff interviews and record review.

For the allegation, staff is verbally abusing residents.

LPA conducted (2) resident interviews. 2 out of the 2 residents stated facility staff do not verbally abuse them. LPA conducted (2) staff interviews. 2 out of the 2 facility staff stated they have not verbally abused any of the clients in care and have not witnessed other facility staff do so.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2025
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 2
Control Number 56-AS-20250916084407
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: PEPPERMINT RIDGE
FACILITY NUMBER: 335530186
VISIT DATE: 09/22/2025
NARRATIVE
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For the allegation, Staff are mismanaging resident's medications.

LPA conducted (2) resident interviews. 2 out of the 2 residents stated facility staff do not mismanage residents medications. LPA conducted (2) staff interviews. 2 out of the 2 facility staff stated they do not mismanage residents medications and all medications are administered as prescribed. LPA observed all (4) residents medications. No issues were observed.

For the allegation, Staff are not meeting residents medical needs.

LPA conducted (2) resident interviews. 2 out of the 2 residents stated facility staff meet their medical needs. LPA conducted (2) staff interviews. 2 out of the 2 facility staff stated all residents medical needs are being met. Staff #2 (S2) reported residents are taken as needed to doctor appointments or hospital visits.

For the allegation, Staff are not providing adequate supervision.

LPA conducted (2) resident interviews. 2 out of the 2 residents stated facility staff are providing adequate supervision. LPA conducted (2) staff interviews. 2 out of the 2 facility staff stated they are providing adequate supervision.

Based on the evidence gathered during today’s investigation, the allegations 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.

During today’s visit pertaining to the allegations listed, no deficiency 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 Jessica Paz.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2025
LIC9099 (FAS) - (06/04)
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