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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 365530326
Report Date: 08/20/2026
Date Signed: 08/20/2026 01:00:13 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
05/15/2026 and conducted by Evaluator Beena Singh
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20260515091315
FACILITY NAME:FISHER MANOR 1FACILITY NUMBER:
365530326
ADMINISTRATOR:QASIM, AHMEDFACILITY TYPE:
740
ADDRESS:25243 FISHER STTELEPHONE:
(909) 885-3330
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92404
CAPACITY:15CENSUS: 15DATE:
08/20/2026
UNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Staff/ Caregiver Annmarie LeonTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff do not safeguard resident's cash resources.
Staff stole resident’s money and personal belongings.
Staff do not ensure residents medication is dispensed properly.
INVESTIGATION FINDINGS:
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On 08/20/2026, Licensing Program Analyst (LPA) Beena Singh conducted an unannounced visit to the facility to initiate and deliver findings on above complaint allegations.
LPA Singh met with Facility Administrator Annmarie Leon, facility representative and was informed of
the visit, the investigation conducted by LPA Singh consisted of interviews and records review.Facility has a census of 15 Residents and one(1) resident is out in the community.

First Allegation:Staff do not safeguard resident's cash resources.
LPA Singh conducted a quick tour of the facility, interviewed residents and staff, obtained pertinent documents.
LPA Singh interviewed Staff and Residents, Four out of Four Staff and Seven(7) out of Seven(7) residents stated former staff had been taking money from the two residents to book taxis, shopping and debit card was being used for unauthorized transactions at locations such as Walmart, Subway, and gas stations. Resident #1 reported that unauthorized charges for Uber taxi bookings continue to be deducted from their bank account, despite having previously contacted their bank to cancel the old card linked to the service. R#2 has been moved out of the facility.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2026
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 3
Control Number 56-AS-20260515091315
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: FISHER MANOR 1
FACILITY NUMBER: 365530326
VISIT DATE: 08/20/2026
NARRATIVE
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Second Allegation: Staff stole resident’s money and personal belongings.
LPA Singh interviewed Staff and Residents, Four(4) out of Four(4) Staff and Seven(7) out of Seven(7) residents stated former staff had been taking money from the two residents to book taxis, shopping and debit card was being used for unauthorized transactions at locations such as Walmart, Subway, and gas stations.
Residents stated that former staff was stealing their money and personal belongings from their rooms.

Third Allegation: Staff do not ensure residents medication is dispensed properly.
LPA Singh interviewed Staff and Residents, Four(4) out of Four(4) Staff and Three(4) out of Seven(7) residents stated facility staff had been dispensing medication properly, However, Four(4) out Seven(7) residents stated that Staff not dispensing/administering medications properly. Also, when LPA Singh reviewed medication records(MAR)of R#3,R#4,R#5,R#6, found Staff#4 has not signed the MAR after administering medications to residents in care for 08/20/2026, morning/AM medications.

Based on observations, interviews, record reviews, and the totality of evidence gathered, there is sufficient
evidence to support the allegations that Staff do not safeguard resident's cash resources, Staff stole resident’s money and personal belongings and Staff do not ensure residents medication is dispensed properly. The preponderance of evidence standard has been met, leading to the substantiated findings.

Current Staff informed LPA SIngh that former Staff in question, has been terminated.

In conclusion, based on all of the information obtained and interviews conducted during the course of the investigation, it is determined that, Staff do not safeguard resident's cash resources, Staff stole resident’s money and personal belongings and Staff do not ensure residents medication is dispensed properly. Therefore, the above allegations are Substantiated at this time.


An exit interview was conducted, and this report (LIC809) LIC 809C, LIC809D and Appeal Rights were
discussed and provided to Facility Staff Annmarie Leon.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 56-AS-20260515091315
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: FISHER MANOR 1
FACILITY NUMBER: 365530326
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/20/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/21/2026
Section Cited
CCR
87217(a-f)
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87217:Safeguards for Resident Cash, Personal Property, and Valuables
(a)A licensee shall not be required to handle residents' cash resources. However, if a resident incapable of handling his own cash resources… his cash resource shall be safeguarded in accordance with the regulations in this
(b)Every facility shall take appropriate measures to safeguard residents' cash resources, personal property and valuables which have been entrusted to the licensee or facility staff. The licensee shall give the residents receipts for all such articles or cash resources.(c)Every facility shall account for any cash resources entrusted to the care or control of the licensee or facility staff.(1)Cash resources include but are not limited….personal and incidental need allowances from funding sources such as SSI/SSP..(3)become substitute payee for any payments made to any persons;(e)Cash resources and valuables of residents which are handled by the licensee for safekeeping shall not be commingled with….facility funds or petty cash, and shall be separate, intact and free from any liability the licensee incurs in the use of his own or the facility's funds and valuables.(f)No licensee or employee of a facility shall make expenditures from residents' cash resources…, or for any basic services identified in a contract/admission agreement between the resident and facility.
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Licensee/Staff to train all staff on CCR 87217(a-f),Safeguards for Resident Cash, Personal Property, and Valuables and submit proof of Training Log to LPA Singh by POC due date. Staff stated to submit signed Statement of Understanding on CCR 87217(a-f) and submit to LPA Singh by POC due date.
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Based on observation,interview,resords review, the Licensee/Staff did not ensure that Staff safeguarded resident's cash resources, which posed an immediate risk to the health and safety of residents in care.
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Type A
08/21/2026
Section Cited
CCR
87919(b)
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CCR87919(b) Facilities must maintain Medication Record for each resident containing the exact time, date, dosage taken, and the names and initials of direct care Staff assisting with the medications.
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Licensee/Staff to train all staff on CCR 87919(b)on Midication Documentation and submit proof of Training Log to LPA Beena Singh by POC due date. Staff stated to submit signed Statement of Understanding on CCR 87919(b) and submit to LPA Singh by POC due date.
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Based on observation,interview,resords review, the Licensee/Staff did not ensure that Staff dispenced/administered/document in MAR, residents medication properly, which posed an immediate risk to the health and safety of residents 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.
SUPERVISOR'S NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3