Complaint Investigation Report

361880724-11-25-2025-56-AS-KCLS-DPGT2Z-20251218132135

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-20251124133424

Facility does not provide adequate amount of incontinence supply

Licensing Program Analysts (LPAs) Sarina Ramirez and Eldin Serrano conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegations. LPAs met with Caregiver Rose Pinella, and discussed the purpose of the visit.

Regarding Allegation above, LPA Serrano toured the facility and observed a sufficent amount of incontinence supplies. R1 receives incontinence supplies provided by Veterans Adminstration (VA). Based on LPAs interviewed two (2) of the three (3) residents receive incontinence care.

Based on LPA’s observations, staff and resident interviews, and relevant documentation, the allegation is determined to be Unsubstantiated. An Unsubstantiated finding means that although the allegation may be valid or could have occurred, there is insufficient evidence to support that the alleged violation did or did not happen.

An exit interview was conducted with Caregiver Rosalinda Pinella, and a copy of this report was provided at the conclusion of the visit.