Complaint Investigation Report

360902944-10-21-2025-56-AS-EMAN-DPETVK-20251216140403

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

10/14/2025 and conducted by Evaluator Raquel Hernandez

COMPLAINT CONTROL NUMBER: 56-AS-20251014211259

Staff did not address resident's change of condition.

Staff did not ensure that resident was adequately fed.

Staff did not ensure that resident's oxygen tank was functioning properly.

Resident was left in soiled diapers resulting in severe rash.

Licensing Program Analyst (LPA) Raquel Hernandez conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Administator Daryll Whitehead and explained the purpose of the visit. The investigation consisted of interviews and document review.

LPA Hernandez observed Resident #1 (R1) was admitted to skilled nursing side of facility. LPA concluded through interviews and document review R1 does not live on assisted living facility side, therefore, investigation is not within jurisdiction of licensing department.

Based on the evidence gathered, the allegation is deemed UNFOUNDED. A finding that the complaint allegation is UNFOUNDED means that the allegation was without a reasonable basis. Therefore, the allegations dismissed. An exit interview was conducted where this report LIC9099 was discussed and provided to Administrator Daryll Whitehead.