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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 365530213
Report Date: 11/21/2024
Date Signed: 11/21/2024 09:47:21 AM

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
11/07/2024 and conducted by Evaluator Beena Singh
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20241107150903
FACILITY NAME:VILLAS AT SAN BERNARDINOFACILITY NUMBER:
365530213
ADMINISTRATOR:CARLTON, KENYAFACILITY TYPE:
740
ADDRESS:2985 N G STREETTELEPHONE:
(323) 475-1800
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92405
CAPACITY:144CENSUS: 93DATE:
11/21/2024
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Facility Administrator Kenya CarltonTIME COMPLETED:
10:15 AM
ALLEGATION(S):
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Staff do not serve quality food to residents.
INVESTIGATION FINDINGS:
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First Complaint: Licensing Program Analyst (LPA) Beena Singh conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Facility Administrator Kenya Carlton and explained the purpose of the visit. The investigation consisted of interviews and review of records.


First Allegation, Staff do not serve quality food to residents.

During interviews with residents, 5 out of 5 residents denied being not serving quality food to residents. All 5 out of 5 residents are happy with choices and quality of food being served at the facility. LPA conducted an interview with Resident #1 who reported to LPA that resident has been looked after by the staff and food service is good. R#1 stated she always has been given good food choices and quality of food is good to better.


Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 56-AS-20241107150903
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: VILLAS AT SAN BERNARDINO
FACILITY NUMBER: 365530213
VISIT DATE: 11/21/2024
NARRATIVE
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Based on the evidence found during the investigation, LPA Beena Singh found the allegation listed above to be Unsubstantiated.

Unsubstantiated: A finding that the complaints are Unsubstantiated means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report was discussed and provided to Facility Administrator Kenya Carlton.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2