Complaint Investigation Report

366425833-8-13-2025-56-AS-NBRN-DLJMYF-20250915100125

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

08/07/2025 and conducted by Evaluator Becky Mann

COMPLAINT CONTROL NUMBER: 56-AS-20250807171708

Licensee is not keeping the facility free from pests

Licensing Program Analyst (LPA) Becky Mann conducted an unannounced visit to the facility to initiate a complaint investigation. LPA met with Rolando Serquinia, Administrator and explained the purpose of the visit. The investigation consisted of LPA pertinent record reviews, observations and interviews with staff.

The allegation that Licensee is not keeping the facility free from pests. Interview with staff revealed that the facility has had an ongoing issue with roaches for a few months. Based on LPA observations, roach excrements were found behind the refrigerator, pantry, and kitchen cabinets. LPA also observed a small size live roach on the top of the fridge door.

Based on observations, interviews, and record reviews, 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 and an exit interview was conducted, and this report LIC9099, LIC9099D and appeal rights were discussed and provided to Rolando, Administrator.