Complaint Investigation Report

336408402-10-8-2025-56-AS-KCLS-DSCUZV-20260320160208

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

10/01/2025 and conducted by Evaluator Sarina Ramirez

COMPLAINT CONTROL NUMBER: 56-AS-20251001104802

Staff did not ensure faciltiy was free from pests

Licensing Program Analysts (LPAs) Sarina Ramirez and Edith Conchas conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegation. LPAs met with House Manager Raven Johnson and explained the purpose of the visit.

Regarding allegation Staff did not ensure faciltiy was free from pests, House Manager confirmed the facility had bed bugs in two (2) bedrooms, the facility has been fumigated on 9/27/25, new mattresses, bed frames, and bed covers were delivered on 9/26/25 and 10/8/25.

Based on observation, record review, and interviews deficiencies were cited per Title 22, Division 6 of The California Code of Regulations.

An exit interview was conducted where the Licensing reports were discussed and copies of the reports with Appeal Rights was provided to House Manager Raven Johnson.