Complaint Investigation Report

360902129-3-24-2026-56-AS-NBRN-DSNNL7-20260330103306

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

07/02/2025 and conducted by Evaluator Raquel Hernandez

COMPLAINT CONTROL NUMBER: 56-AS-20250702143431

Staff administered resident a nonprescribed medication

Licensing Program Analyst (LPA) Raquel Hernandez conducted an unannounced visit to investigate allegations above. LPA met with Administrator Melanie Niez and explained the purpose of the visit. The investigation consisted of facility tour, resident interviews, and staff interviews.

On 07/02/2025, the licensing department received a complaint in regards to staff administering residents a nonprescribed medication. LPA conducted (8) resident interviews. 8 out of the 8 residents stated facility staff have not administered any nonprescribed medications. Also, LPA conducted (6) staff interviews. 6 out of the 6 staff stated they have not and or witnessed any staff administer a nonprescribed medication.

Based on the evidence gathered during today’s investigation, the allegation listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted and this report (LIC9099) were discussed and provided to Administrator Melanie Niez.