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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 365530213
Report Date: 05/01/2026
Date Signed: 05/01/2026 03:52:24 PM

Substantiated


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
11/17/2025 and conducted by Evaluator Renese Howell-Small
COMPLAINT CONTROL NUMBER: 56-AS-20251117144330
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: 95DATE:
05/01/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Executive Director, Jacqueline CortezTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Resident developed a parasitic infection due to staff neglect.
INVESTIGATION FINDINGS:
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On 05/01/2026 at 9:30AM Licensing Program Analyst (LPA) Renese Howell-Small arrived unannounced to the facility to conclude the investigation and deliver findings for the above allegation. LPA introduced self and was greeted by staff. LPA met with Administrator,Yvette Navarro and Exective Director, Jacqueline Cortez, and discussed the purpose of the visit. The investigation consisted on interviews and record review.

The allegation that resident developed a parasitic infection due to staff neglect:
LPA interviewed ten (10) staff. Staff stated that they observe any change in a resident's condition, document it and report it to a supervisor.Resident 1 (R1) recieved wound care through a health agency on a weekly basis. R1 last received care from the health agency on 11/12/2025. R1 was sent to the hospital on 11/15/2025; the wound developed parasites. Based on interview and record review, this allegation is SUBSTANTIATED.

SUBSTANTIATED is defined as the complaint allegation(s) is valid and a violation has occurred based on the preponderance of available evidence. A deficiency will be cited. An exit interview was conducted where this report LIC9099, LIC9099D and Appeal Rights were discussed, and copies wer provided to Executive Director, Jacqueline Cortez.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Renese Howell-Small
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2026
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-20251117144330
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/01/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/02/2026
Section Cited
HSC
1569.725(a)(4)
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Incidental medical care 1569.725(a)(4) A residential care facility for the elderly may permit incidental medical services ...(4) There is ongoing communication... about the services provided... and the frequency and duration of care to be provided. This requirement was not met as evidenced by:
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The Administrator will conduct a training with staff regarding the non-medical care of wounds and will request a meeting with the health agency to discuss the required documentation for residents receiving wound care and will submit proof to LPA by Plan of Correction (POC) due date.
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Based on interview and a review of facility records, the facility did not ensure Resident 1 (R1) wound care was maintained by the health agency in which the wound developed parasites (maggots), which posed an immediate risk to the health and safety of the resident in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Renese Howell-Small
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2026
LIC9099 (FAS) - (06/04)
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