365530213-10-27-2025-56-AS-NBRN-DNQRC2-20251124115339

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 365530213
Report Date: 10/27/2025
Date Signed: 10/27/2025 03:03:32 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
06/20/2025 and conducted by Evaluator Renese Howell-Small

COMPLAINT CONTROL NUMBER: 56-AS-20250620132232

FACILITY NAME:	VILLAS AT SAN BERNARDINO		FACILITY NUMBER:	365530213
ADMINISTRATOR:	CARLTON, KENYA		FACILITY TYPE:	740
ADDRESS:	2985 N G STREET		TELEPHONE:	(323) 475-1800
CITY:	SAN BERNARDINO	STATE: CA	ZIP CODE:	92405
CAPACITY:	144	CENSUS: 91	DATE:	10/27/2025
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Executive Director, Kenya Carlton		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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9

Due to lack of supervsioin, resident was assaulted by another resident resulting in injury

INVESTIGATION FINDINGS:

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On 10/27/2025 at 10:00AM 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 Executive Director, Kenya Carlton. The investigation consisted of interviews and record review.

The allegation of due to lack of supervsioin, resident was assaulted by another resident resulting in injury:
LPA interviewed the relative of Resident 1 (R1) and four (4) staff. The relative of R1 stated that they do not have any concerns with the facility and R1 is safe. Staff denied the allegation and stated that staff were available to assist the residents. The facility reported the incident to the Department and a report was filed with law enforcement. 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 Executive Director, Kenya Carlton.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Renese Howell-Small
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2025

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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