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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 365530213
Report Date: 10/10/2025
Date Signed: 10/10/2025 12:57:24 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
08/25/2025 and conducted by Evaluator Renese Howell-Small
COMPLAINT CONTROL NUMBER: 56-AS-20250825103602
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: 88DATE:
10/10/2025
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Executive DIrector, Kenya CarltonTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff does not keep resident’s room free from bed bugs
Staff does not have enough bed linens for residents
Staff does not keep residents bathroom clean


INVESTIGATION FINDINGS:
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On 10/10/2025 at 9:10AM Licensing Program Analyst (LPA) Renese Howell-Small conducted an unannounced visit to the facility in order to deliver findings for the above allegations. LPA discussed the purpose of the visit with Executive Director, Kenya Carlton. The investigation consisted of interviews observation and record review.

In regards to the allegation of Staff does not keep resident’s room free from bed bugs:
LPA interviewed staff and residents. LPA observed the invoice from Ecolab dated 08/25/2025 which serviced the facility for bed bugs and the invoice dated 09/05/2025 did not find bed bug activity. Residents stated that the facility took care of the pests. Based on interviews and record review, this allegation is UNSUBSTANTIATED.

In regards to the allegation of staff does not have enough bed linens for residents:
LPA interviewed staff and observed and observed an adequate supply of linen in the laundry room on the first floor of the facility.
*Continued on LIC9099C*
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Renese Howell-Small
LICENSING EVALUATOR SIGNATURE:

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

DATE: 10/10/2025
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-20250825103602
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: 10/10/2025
NARRATIVE
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 LPA observed a sample of resident rooms and all of the rooms had linen on their beds and extra linen in their closets. Based upon interviews and observation, this allegation is UNSUBSTANTIATED.

In regards to the allegation of staff does not keep residents bathroom clean:
LPA interviewed staff and residents. Staff stated that rooms are cleaned once a week or more if needed. LPA observed a sample of resident rooms and bathrooms were clean. LPA also observed housekeeping staff and their cleaning carts with supplies during the visit. Based upon interviews and observation, 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(s) occurred.

An exit interview was conducted where this report LIC9099, LIC9099C was discussed and a copy was provided to the Executive Director.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Renese Howell-Small
LICENSING EVALUATOR SIGNATURE:

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

DATE: 10/10/2025
LIC9099 (FAS) - (06/04)
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