PEPPERMINT RIDGE - DUDLEY HOME
ICF/DD-N (Nursing) · 6 licensed beds · Corona, CA
Homes of 4–15 beds for medically fragile people with developmental disabilities who need intermittent skilled nursing.
Address
PEPPERMINT RIDGE - DUDLEY HOME4289 SHOALCREEK DRCorona, CA 92883 · Riverside CountyPhone: (951) 273-7331
State penalties
0
none on record since 1998
Federal surveys
43
since 2018 · 11 with deficiencies
Federal deficiencies
32
none condition-level
Last federal survey
Sep 22, 2026
survey date
Facility details
- Facility type
- ICF/DD-N (Nursing)
- Licensed beds
- 6
- Licensee
- PEPPERMINT RIDGE · Nonprofit Corp
- Administrator
- ELAD, MACARIUS
- CDPH facility ID
- 630012512
- License number
- 550001274
- First licensed
- May 13, 2010
- Current license
- May 13, 2026 to May 12, 2027
- CDPH district office
- Riverside
Federal certification (CMS)
- CMS Certification Number (CCN)
- 55G652
- Status in CDPH's listing
- Licensed And Certified
- Program
- Medi-Cal (Medicaid, Title XIX)
- Participating since
- November 29, 2010
- Last certification survey
- August 12, 2025
- CMS certification status
- Certified
- In compliance (CMS)
- Yes
- Last certification action
- Recertification
- Ownership type (CMS)
- Private (non-profit)
- Certified beds (CMS)
- 6
- Staffing reported to CMS
- RN 0.01 · LVN/LPN 0.02 · direct care 0.06 · all employees 0.09
State citations and penalties (CDPH)
CDPH issues citations under Health and Safety Code §1424: Class AA (a violation that was a substantial factor in a resident's death), Class A (imminent danger or a substantial probability of death or serious harm) and Class B (a direct relationship to residents' health, safety or security). State citations explained
No state citations or penalties on record for this facility in CDPH's enforcement data (July 1998 to date).
Federal inspections (CMS-2567)
CDPH surveys certified ICFs for CMS. Each deficiency is a W-tag (a federal ICF/IID requirement), an E-tag (emergency preparedness) or a K-tag (Life Safety Code), cited at the standard level or, more seriously, the condition level. How to read an ICF inspection
Content note: these federal findings describe residents' care and can include abuse, neglect, injuries and medical details. They're shown as CMS published them; residents are identified only by number (such as "Client 1").
· Complaint
Event 3C5C98-H1 · no deficiencies cited
· Complaint
Event 341CBE-H1 · no deficiencies cited
· Complaint
Event 31C371-H1 · no deficiencies cited
· Complaint
Event 2CFCAF-H1 · no deficiencies cited
· Complaint
Event 23266C-H1 · no deficiencies cited
· Complaint
Event JMS911 · no deficiencies cited
· Complaint
Event QY9Y11 · no deficiencies cited
· Recertification
Event TDPY21 · no deficiencies cited
From CMS's QCOR ICF/IID statement-of-deficiency download, saved Oct 26, 2026. CMS notes that ICF/IID data after March 19, 2026 may be incomplete while its systems migrate. Plans of correction and state-only (licensing) deficiencies aren't in that file; the official 2567 documents on CalHealthFind have them.
Complaints and reported incidents
CDPH doesn't publish complaints or facility-reported incidents as a bulk file, so they aren't on ICFLookup. Its CalHealthFind page for this facility lists them (intake date, allegation category and whether each was substantiated), along with state licensing deficiencies and ownership details.
Federal surveys that came from a complaint or an incident report do appear above, marked "Complaint" as the survey type.
Open this facility on CalHealthFind ↗How to file a complaint with CDPH
Change history
44 events, newest first
Dates marked "state record" are the agencies' own: the license date, federal survey dates and penalty issue dates. "Detected" changes are ones we noticed by comparing CDPH's monthly facility listing with the one before it, tracked since Oct 26, 2026.
ReportFederal survey (complaint): no deficiencies(state record)
ReportFederal survey (complaint): no deficiencies(state record)
ReportFederal survey (complaint): no deficiencies(state record)
ReportFederal survey (complaint): 1 deficiency(state record)
ReportFederal survey (complaint): no deficiencies(state record)
ReportFederal survey (complaint): 1 deficiency(state record)
ReportFederal survey (complaint): no deficiencies(state record)
ReportFederal survey (complaint): 2 deficiencies(state record)
ReportFederal survey (complaint): no deficiencies(state record)
ReportFederal survey (complaint): no deficiencies(state record)
Sources: CDPH Licensed and Certified Healthcare Facility Listing (data as of Oct 16, 2026), CDPH State Enforcement Actions, and CMS's ICF/IID statement-of-deficiency (CMS-2567) and Provider of Services files. ICFLookup is not affiliated with CDPH or CMS; always confirm with CDPH's CalHealthFind ↗ before making a decision. See How our data works.