Complaint Investigation Report

331880604-5-15-2026-56-AS-KCLS-DWGP3Q-20260730105751

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

11/25/2025 and conducted by Evaluator Raquel Hernandez

COMPLAINT CONTROL NUMBER: 56-AS-20251125220805

Staff did not seek medical care for resident in a timely manner

Licensing Program Analyst (LPA) Raquel Hernandez conducted an unannounced visit to deliver findings for the allegations above. LPA met with Staff Nestor Frijas and explained the purpose of the visit. The investigation consisted of facility tour and staff interviews

On 11/25/2025, the department received a complaint regarding staff not seeking medical care for resident in a timely manner. Interviews revealed that Staff #1 noticed Resident #1 (R1) face to be swollen Sunday night on 11/23/2025 but did not take R1 to the hospital or call emergency services. R1 was then taken to hospital next morning as swelling began to worsen.

Based on the evidence gathered during today’s investigation, the allegation listed above are deemed SUBSTANTIATED. A finding that the complaints are SUBSTANTIATED means that the allegation are valid because the preponderance of evidence the standard has been met. An exit interview was conducted and a copy of this report (LIC9099) and (LIC9099A) was discussed and provided to Administrator Ghislaine Ramasar along with copy of appeal rights.