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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 365530138
Report Date: 10/02/2025
Date Signed: 10/02/2025 02:03:42 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/11/2025 and conducted by Evaluator Renese Howell-Small
COMPLAINT CONTROL NUMBER: 56-AS-20250811151313
FACILITY NAME:WHITE HOUSE, THEFACILITY NUMBER:
365530138
ADMINISTRATOR:BICKHAM, EDDIEFACILITY TYPE:
735
ADDRESS:15363 PATTON STTELEPHONE:
(760) 596-0749
CITY:VICTORVILLESTATE: CAZIP CODE:
92394
CAPACITY:4CENSUS: DATE:
10/02/2025
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Administrator, Eddie BickhamTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not assist resident with administering medication resulting in resident choking
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 10/02/2025 at 12:30PM Licensing Program Analyst (LPA) Renese Howell-Small conducted an unannounced visit to the facility in order to deliver findings for the above allegation. LPA discussed the purpose of the visit with Aministrator, Eddie Bickham. The investigation consisted of interviews and record review.

In regards to the allegation of staff did not assist resident with administering medication resulting in resident choking:
LPA interviewed four (4) staff and (3) clients. LPA observed three clients in care during the visit. Client 1 (C1) denied the allegation and stated that they take their medications without any concerns. C1 stated that some of the medication makes them sleepy, but denied choking. LPA audited the clients' medications and notes for the months of August and September and did not observe any discrepancies. Staff denied the allegation and stated that they are trained to assist all of the clients with medication. LPA also reviewed the facility's Consumer Notes for C1 and C2 and did not observe any notes on choking or medication incidents. Based on interviews and record review, this allegation is UNSUBSTANTIATED.

UNSUBSTANTIATED is defined as the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted where this report LIC9099 was discussed and a copy was provided to Administrator, Eddie Bickham.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Renese Howell-Small
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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