Complaint Investigation Report

366425610-12-2-2025-56-AS-KCLS-DPGTCP-20251218133705

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

11/24/2025 and conducted by Evaluator Sarina Ramirez

COMPLAINT CONTROL NUMBER: 56-AS-20251124161821

Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegation. LPA met with Administrator Dorris Anderson, and discussed the purpose of the visit.

It is alleged staff are not following physician’s orders, based on record review, interviews with residents staff and Licensee. LPA did not find any discrepancies to corroborate the allegation.

LPA was unable to interview R1 due to no longer residing at the facility, R1 moved out the day before Thanksgiving on 11/26/25. Therefore, the allegation above 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 Caregiver Myrna Jackson and a copy of this report was provided at the conclusion of the visit.