Complaint Investigation Report

335530266-4-24-2025-56-AS-KCLS-DKYPL3-20250828112405

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

SAN BERNARDINO ASC , 1650 SPRUCE ST STE 200 MS29-27

This is an official report of an unannounced visit/investigation of a complaint received in our office on

04/21/2025 and conducted by Evaluator Sarina Ramirez

COMPLAINT CONTROL NUMBER: 56-AS-20250421152622

Licensing Program Analysts (LPAs) Sarina Ramirez and Eldin Serrano conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegation. LPA met with Executive Director Cristina Ceballos, and discussed the purpose of the visit.

Interviews conducted with staff, residents, and outside parties revealed that around 4/18/25, Resident 1 (R1) sustained unexplained bruising. After an internal investigation, and interviews with staff; staff suspect Resident 2 (R2) attempted to remove R1’s doll and may have caused the unexplained bruising. Due to both residents being in memory care there is not enough evidence to prove how R1 sustained the unexplained bruising.

Based on observation, interviews, and pertinent documents the allegation is unsubstantiated. An Unsubstantiated complaint means, that although the allegation 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 with Executive Director Cristina Ceballos and a copy of this report was provided at the conclusion of the visit.