Complaint Investigation Report

360900455-12-26-2024-56-AS-KCLS-DCG6PA-20241230195848

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

12/20/2024 and conducted by Evaluator Sarina Ramirez

COMPLAINT CONTROL NUMBER: 56-AS-20241220125755

Staff did not respond to resident's call button in a timely manner.

Staff did not follow resident's diet plan.

Staff did not allow resident use restroom.

Staff does not ensure facility is free of pests.

Staff did not ensure resident's bathroom is clean and sanitized.

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

Regarding allegations above, The Administrator informed LPA that resident #1 (R1) never resided in the assisted living facility but resided in the skilled nursing facility. LPA obtained a resident roster from the skilled nursing facility that verifies R1 lived at the skilled nursing facility. Based on LPA's interviews and record review, the above allegation is Unfounded.

An Unfounded finding means, the allegation is false, could not have happened, and/or is without a reasonable basis.

An exit interview was conducted where this report was discussed and a copy of this report was provided to Administrator Jessica Ramos at the conclusion of the visit.