Complaint Investigation Report

366423704-6-9-2025-56-AS-KCLS-DJKSMZ-20250714140047

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

04/01/2025 and conducted by Evaluator Sarina Ramirez

COMPLAINT CONTROL NUMBER: 56-AS-20250401124750

Staff did not inform authorized representative of residents death

Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to deliver findings on the allegations mentioned. LPA met with House Manager Denise Colvin and explained the purpose of the visit. LPA's investigation involved interviews and records review.

It is alleged staff did not inform Authorized Representative of Resident 1 (R1) death. LPA never received clarification on who R1 was. LPA conducted interviews with staff stating when residents pass the Administrator follows up with their responsible parties. Administrator provided documentation to corroborate the attempted communication to R1’s authorized representative.

Based on LPAs record review, interviews, and lack of evidence the above allegation is Unsubstantiated. A finding that complaints are UNSUBSTANTIATED means although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted, and this report was discussed and provided to