365530230-6-2-2026-56-AS-NBRN-DYCRR9-20260928131446

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 365530230
Report Date: 05/27/2026
Date Signed: 06/02/2026 12:02:19 PM

Substantiated

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
05/26/2026 and conducted by Evaluator Edith Conchas

COMPLAINT CONTROL NUMBER: 56-AS-20260526155400

FACILITY NAME:	CANYON VIEW PACIFIC HOME INC.		FACILITY NUMBER:	365530230
ADMINISTRATOR:	SANTOS, AMANDA		FACILITY TYPE:	740
ADDRESS:	1438 PACIFIC STREET		TELEPHONE:	(909) 548-1769
CITY:	REDLANDS	STATE: CA	ZIP CODE:	92373
CAPACITY:	14	CENSUS: 7	DATE:	05/27/2026
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Iren Creighton, administrator		TIME COMPLETED:	04:10 PM

ALLEGATION(S):

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Uncleared staff are working at the facility.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) E. Conchas conducted an unannounced visit to the facility to commence a complaint investigation and deliver findings on the allegations stated above. LPA observed the facility, conducted interviews with staff, residents and witnesses.

Uncleared staff are working at the facility.
LPA interviewed staff and conducted record reviews. Interview with staff reveal S2 has been working at the the facility for over a week. Facility records indicate the earliest S2 signed in in the employee sign-in sheet was May 2nd through May 7th, 2026. Records observation of S2 file did not reveal any clearance record. CCL records indicate staff was not associated until May 12th, 2026. Based on the interviews and observation this allegation is Substantiated

Based on interviews, and record review, the allegation is SUBSTANTIATED. The finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. An exit interview was conducted where a copy of this report and appeal rights were discussed and provided to Administrator, Iren Crieghton.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Edith Conchas
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 56-AS-20260526155400

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: CANYON VIEW PACIFIC HOME INC.	FACILITY NUMBER: 365530230
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/27/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 05/28/2026 Section Cited CCR 87355(e)(2)	1 2 3 4 5 6 7	87355Criminal Record Clearance(e)All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17 (2)Obtain a California clearance or a criminal record exemption as required by the Department or. THis requirement is not met as eviddenced by:	1 2 3 4 5 6 7	Licensee to obtain a clearance for S2, associate them to the facility and maintain an employee file at the facilty and provide a copy to LPA by POC date.
	8 9 10 11 12 13 14	Based on interview and record review licensee did not comply with the section cited above by allowing staff 2 (S2) to sign in the staff sign in sheet five different days prior to obtaining a California clearance to work at this facility.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Karen Clemons
LICENSING EVALUATOR NAME: Edith Conchas
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 4

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
05/26/2026 and conducted by Evaluator Edith Conchas

COMPLAINT CONTROL NUMBER: 56-AS-20260526155400

FACILITY NAME:	CANYON VIEW PACIFIC HOME INC.		FACILITY NUMBER:	365530230
ADMINISTRATOR:	SANTOS, AMANDA		FACILITY TYPE:	740
ADDRESS:	1438 PACIFIC STREET		TELEPHONE:	(909) 548-1769
CITY:	REDLANDS	STATE:CA	ZIP CODE:	92373
CAPACITY:	14	CENSUS: 7	DATE:	05/27/2026
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:			TIME COMPLETED:	04:10 PM

ALLEGATION(S):

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Licensee is drinking alcohol with the residents.
Licensee is not serving a balanced meal.

INVESTIGATION FINDINGS:

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Edith Conchas
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 56-AS-20260526155400

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: CANYON VIEW PACIFIC HOME INC.	FACILITY NUMBER: 365530230
	VISIT DATE: 05/27/2026

NARRATIVE

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License is not serving a balanced meal.
Interviews with staff and residents revealed that staff do provide food for residents during breakfast, lunch and dinner. For breakfast clients were served waffles, eggs, sausage and orange juice. During lunch time, LPA observed a meal provided of fried chicken, Barbecue beans, potato salad and cottage with strawberries and banana for dessert. Based on the interviews this allegation is UNSUBSTANTIATED.

Based on the information above, the allegations are unsubstantiated. A finding of UNSUBSTANTIATED means although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted where this report was discussed, and a copy was provided to administrator Iren Creighton.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Edith Conchas
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2026

LIC9099 (FAS) - (06/04)

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