Complaint Investigation Report

336426057-1-3-2025-56-AS-EMAN-DDB7DH-20250126203421

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

01/02/2025 and conducted by Evaluator Raquel Hernandez

COMPLAINT CONTROL NUMBER: 56-AS-20250102114408

Licensing Program Analysts (LPA) Raquel Hernandez conducted an unnannounced visit for the purpose of investigating the above allegation. LPA met with Staff Victoria Ochava and explained the purpose of the visit. The investigation consisted of facility tour and record review.

For the allegation, Resident record are not completed. LPA Hernandez conducted a record review for former Client #1 (C1). During record review LPA observed no admission agreement for C1 or a completed record.

Based on observations and record review, the allegation is SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. During today’s visit, a deficiency was cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report LIC9099, LIC9099C and LIC9099D were discussed and provided to Licensee Laarni Dizon along with a copy of appeal rights.