Peppermint Ridge

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Andrew Martinez made an unannounced visit to the facility for the purpose of conducting the required comprehensive annual inspection. LPA met with Facility Manager Claudia Cortes and was granted entry to the facility. At time of the visit there were (2) staff and (4) residents present. Facility Administrator Stephanie Barron was contacted and informed of the LPA's arrival and administrator arrived shortly after. LPA Martinez explained the purpose of the visit to Administrator Stephanie Barron. The facility is a (4) bedroom, (2.5) bathroom home with a (2) car attached garage. There is a kitchen, dining/ family area, living room, and staff study. The facility is the Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of (4) non-ambulatory/bedridden residents with delayed egress not permitted. The facility has a hospice waiver for (2) residents, and the current census is (4) residents. LPA was accompanied by a to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). LPA observed no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 73 degrees Fahrenheit (F). LPA inspected resident bedrooms; all equipped with the necessary furniture (e.g., mattresses, lamps, chairs, storage space) and sufficient lightning per regulation. LPA observed that bathrooms were clean, and all bathroom fixtures and equipment were operating appropriately. LPA observed grab bars and non-skid mat in the resident bathrooms. LPA observed sufficient furniture/seating to accommodate indoor and outdoor activities for residents in care and guests. LPA measured taps delivering hot water in the bathroom and kitchen to be at 107 degrees F. The facility is equipped with operating combination smoke alarms and carbon monoxide detectors. *** Continuation in LIC 809-C *** Physical Plant continued: Postings such as personal rights, the CCLD complaint poster, Ombudsman Poster, Labor Laws, facility license, administrator's certificate, and the Emergency Disaster plan were posted in a common area. Sharps were kept locked and inaccessible to residents in care. There is designated storage spaces for residents and staff files, and locked cabinets in the staff study storing residents’ medications. Food Service: Seven (7) days non-perishable and three (3) days perishable food supply observed at the facility. Food preparation surfaces are kept clean and there is a sufficient amount of tableware (e.g. plates, cups, utensils, etc.) to accommodate residents in care. Care & Supervision: LPA observed the facility's current Personnel Report LIC 500 and staff schedule shows a sufficient number of staff scheduled to provide twenty-four hour supervision to the residents in care. Record Review: LPA reviewed (3) completed resident files for admission agreements, updated physician reports, and pre-placement appraisals, as well as their Medications Administration Record (MAR) showing no errors/issues. LPA reviewed three (3) completed staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings with tuberculosis (TB) test results. Disaster/earthquake/fire drills were observed to be conducted quarterly on a shift-rotational basis. Based on today's observations (1) Technical Violation is being cited based on Title 22 California Code of Regulations. An exit interview was conducted where this Facility Evaluation Report (LIC 809, LIC 809-C) and Appeal Rights were discussed and copies were provided to Administrator Stephanie Barron.the state’s words, verbatim · CDSS document, Aug 17, 2026

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Staff did not provide adequate food service

Licensing Program Analyst (LPA) Hannah Rodgers conducted an unannounced visit to initiate and deliver findings regarding the above complaint allegation. LPA introduced herself and disclosed the purpose of the visit to Administrator Stephanie Barron. On February 24, 2026, it was alleged that staff did not provide adequate food service. According to the allegation received, the food that was bought for the facility was food that residents do not eat or cannot eat. It was alleged that staff are only providing residents with food that staff enjoy and residents do not. The Department’s investigation consisted of an unannounced facility visit, records review, and staff and resident interviews. [CONTINUED ON LIC9099-C] Unsubstantiated Interviews with staff and residents did not reveal concern with the meals and snacks provided for residents. During LPA’s visit on March 4, 2026, LPA observed at least 2-days perishable food and at least 7-days non-perishable food all safely stored. Review of the facility food menu did not reveal inadequate meals were provided. Based on LPA observations, interviews, and record review, the investigation did not yield a preponderance of evidence to conclude staff did not provide adequate food service. Based on the foregoing, the allegation is unsubstantiated. This finding means that although the allegation may have happened or may be valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Operations Manager Jessica Paz, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Mar 4, 2026 · control 56-AS-20260224094307

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Hannah Rodgers conducted an unannounced case management visit to. LPA was greeted by, identified herself to, and explained the purpose of the visit with Administrator Stephanie Barron & Operations Manager Jessica Paz. On November 20, 2025, the facility self-reported an incident that occurred on November 19, 2026, involving Staff #1 (S1) using the facility debit card to make personal charges. The charges made by S1 would have come from Resident #1 (R1)’s P&I balance [See LIC811 Confidential Name List for identification of select person identifiers used in this report]. During today’s visit, LPA observed residents in care, reviewed facility records, and interviewed residents and staff. There were no deficiencies cited during today's visit and an exit interview was conducted with Operations Manager Jessica Paz, to whom a copy of this report, and the Licensee/Appeal Rights (LIC9058 03/22) were provided to.the state’s words, verbatim · CDSS document, Mar 4, 2026

Allegation investigated: Licensee did not ensure the facility had sufficient staffing. Licensee falsified records.

Licensing Program Analyst (LPA) Hannah Rodgers conducted an unannounced visit to deliver findings regarding the above complaint allegations. LPA introduced herself and disclosed the purpose of the visit to Operations Manager Jessica Paz. On October 6, 2025, it was alleged that licensee did not ensure the facility had sufficient staffing and licensee falsified records. The Department’s investigation consisted of an unannounced facility visit, records review, and staff and resident interviews. According to the allegations received, Resident #1 (R1) requires a Hoyer lift and two staff members to transfer them. However, the facility was understaffed and there have been incidents where there is only one staff member at the facility. Also, the staff were incorrectly filling out Medication Administration Records (MARs) and other pertinent documents at the facility. [Continued on LIC9099-C] Substantiated Review of R1’s medical assessment date May 22, 2025, revealed that R1 is non-ambulatory and can feed themself but required assistance with all other Activities of Daily Living (ADLs). Interviews revealed that R1 requires a Hoyer lift to be transferred to their wheelchair from their bed. Interviews also revealed that the Hoyer lift requires two (2) staff members, and there have been instances where there is only one (1) staff member on-site at the facility. Due to only one (1) staff member being present at the facility, R1 could not be transferred until another staff member had to be called to come to the facility and assist with the transfer. During LPA’s initial visit on October 14, 2025, from 9:20AM-11:15AM, LPA reviewed facility records. Review of the residents’ MARs revealed that a staff member had initiated an administration at 12:00PM prior to it being 12:00PM. Review of R1’s repositioning checklist also revealed that a staff member had initialed the repositioning of R1 at 12:00PM and at 2:00PM prior to those times. The Department has investigated the above-mentioned allegations and based on interviews and records review, the preponderance of evidence exists to support the allegations. Two deficiencies are being cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D). An exit interview was conducted with Operations Manager Jessica Paz, to whom a copy of this report, LIC 9099-C, LIC 9099-D, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided to. Review of R1’s medical assessment date May 22, 2025, revealed that R1 is non-ambulatory and can feed themself but required assistance with all other Activities of Daily Living (ADLs). Interviews revealed that R1 requires a Hoyer lift to be transferred to their wheelchair from their bed and the Hoyer lift requires two (2) staff members to operate it. Interviews did not reveal that staff have transferred R1 with only one (1) staff member nor have staff operated the Hoyer lift if they are the only staff on site at the facility. Review of staff training records did not reveal that staff are untrained in medications. Records reviewed revealed that current medication trainings were maintained on file for staff members. Based on interviews and records review, the investigation did not yield a preponderance of evidence to conclude that staff did not meet resident’s transfer needs and staff did not have medication training. Based on the foregoing, the allegations are unsubstantiated. This finding means that although the allegation may have happened or may be valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted with Operations Manager Jessica Paz, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Oct 24, 2025 · control 56-AS-20251006094602

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(a) · Plan of correction due date: Nov 21, 2025

87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs... This requirement was not met as evidenced by: Based on interviews and records review, the licensee did not comply with the section cited above in that there was not sufficient number of staff to transfer Resident #1 (R1) which posed a potentional health, safety, or personal rights risk to one (1) out of four (4) persons in care.the state’s words, verbatim · CDSS document, Oct 24, 2025

Plan of correction: Licensee agrees to conduct an in-house training on staffing requirements and submit training agenda and sign-in sheet to the Department by POC date of 11/21/2025.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87207 · Plan of correction due date: Nov 21, 2025

87207 False Claims No licensee... or employee of a licensee shall make or disseminate any false or misleading statement regarding ... any of the services provided by the facility. This requirement was not met as evidenced by: Based on records review, the licensee did not comply with the section cited above in that resident records were falsely filled out in advance for Resident #1 (R1) which posed a potential health and safety risk to one (1) out of four (4) persons in carethe state’s words, verbatim · CDSS document, Oct 24, 2025

Plan of correction: Licensee agrees to conduct an in-house training on medication administration and submit training agenda and sign-in sheet to the Department by POC date of 11/21/2025.

Allegation investigated: 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.

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 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.the state’s words, verbatim · CDSS document, Sep 22, 2025 · control 56-AS-20250916084407

Type of visit: Required - 1 Year

On 08/21/2025, at 09:15 AM, Licensing Program Analyst (LPA) Beena Singh made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA Singh met with a staff and was granted entry to the facility. At the time of the visit there were two (2) staff present, and five (5) residents present. Facility Administrator Stephanie Barron was contacted and informed of the visit, administrator Stephanie Barron arrived during the visit. LPA Singh explained the purpose of the visit to Administrator Stephanie Barron. The facility is a four (4) bedroom, two and a half (2 1/2) bathroom home with a attached garage. There is a kitchen/dining area, living room, activity room and laundry area. The facility is the Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of four (4) residents of which three (3) can be non-ambulatory and one (1) bedridden. The current census is two (2) residents. LPA was accompanied by administrator Stephanie Barron to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). LPA observed no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 74 degrees Fahrenheit. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, lamps and storage space. LPA observed sufficient lightning. Moreover, LPA observed that bathrooms were clean, and appliances were operating appropriately. LPA observed grab bars and non-skid mat in the resident bathrooms. LPA observed sufficient furniture and lighting throughout the facility. LPA measured and observed the water temperatures in the bathroom to be at 106 degrees Fahrenheit. The facility is equipped with operating smoke detectors and carbon monoxide alarms. ***Continuation in LIC809C *** Posters such as personal rights, the CCLD complaint poster, Ombudsman Poster, Labor Laws and the Emergency Disaster plan were posted in a common area. LPA observed the knives locked and inaccessible to residents in care. There was a designated storage space for resident/staff files. There is a cabinet in the staff office with the residents’ medications locked in the medication cabinet. Food Service: Seven (7) days non-perishable and three (3) days perishable food supply observed at the facility. Care & Supervision: The facility has certified administrators. LPA Singh observe sufficient number of staff to provide care and supervision to the residents in care. Record Review: LPA reviewed three (3) resident files for admission agreements, updated physician reports, and pre-placement appraisals. The files reviewed were complete. LPA reviewed three (3) personnel files- one(1) administrator and two(2) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings with tuberculosis (TB) test results. Fire drill conducted on 05/28/2025 and earthquake drill was conducted on 06/20/2025 at the facility. LPA Singh also reviewed medications administration record (MAR), was complete, no issues. An exit interview was conducted where this report LIC809, LIC809C were discussed and provided to Facility Administrator Stephanie Barron and operations manager-Jessica Paz.the state’s words, verbatim · CDSS document, Aug 21, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) conducted an announced Pre licensing visit 07/08/2024 at 09:08 AM. This is an announced Pre-Licensing visit conducted with Administrator Jessica Paz who assisted in the tour of inside and outside of facility and the evaluation. The follow up visit was made and observed the following. The facility is a four (4) bedroom and two and a half (2 1/2) bathroom home with an attached garage. Facility tour reveals the physical plan meeting regulations. Water temperature 113.5 degrees. Facility has appropriate furnishings to meet the needs of the resident. Outdoor tour has shaded areas and free from obstructions. The facility has locked cabinets where medication, disinfectants, and other items that are to be inaccessible to clients are needed. The facility carbon monoxide and smoke detectors were tested and found to be in working order. On this date, a COMP III orientation was conducted. The facility was evaluated in accordance with the California Code of Regulations (CCR), Title 22, CCR. Based on the observations and evaluation of the facility this date, the facility’s ready for licensure. Administrator will be notified once facility is licensed. An exit interview was conducted, and a copy of this report (LIC809) was discussed and provided with Administrator Jessica Paz.the state’s words, verbatim · CDSS document, Jul 8, 2024

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 4 Census (if any clients in care): 0 COMP II Participants: MCCARNS, DANEETE - APPLICANT & BARRON, STEPHANIE - ADMINISTRATOR Interview Method: Virtual interview (Skype, Go To Meeting, etc) On 04/11/2024, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Apr 11, 2024