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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366413072
Report Date: 02/06/2024
Date Signed: 02/06/2024 09:57:01 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/30/2024 and conducted by Evaluator Anna Bueno
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240130134400
FACILITY NAME:VILLAS AT SAN BERNARDINOFACILITY NUMBER:
366413072
ADMINISTRATOR:CARLTON, KENYAFACILITY TYPE:
740
ADDRESS:2985 NORTH G STREETTELEPHONE:
(909) 883-7703
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92405
CAPACITY:97CENSUS: 77DATE:
02/06/2024
UNANNOUNCEDTIME BEGAN:
09:22 AM
MET WITH:Kenya CarltonTIME COMPLETED:
09:58 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is trying to illegally evict resident.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced visit to this facility for the purpose of initiating the investigation and delivering finding of the allegation listed above. LPA met with executive director Kenya Carlton and was advised of the purpose of visit. The investigation consisted of records review and interviews with relevant parties.

It is alleged that the Facility is trying to illegally evict resident. Interviews with relevant parties revealed that the facility provided a 60 day notice to relocate. Staff interview further revealed that staff have been working with the local long term care ombudsman who visited the facility and spoke with residents about the notice. LPA reviewed the notice and found that the facility offers options and/or arrangements instead of relocating from this facility.

Based on the available information, we have found the complaint allegation is UNSUBSTANTIATED. A finding of unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted where this report was discussed and a copy was provided executive director Kenya Carlton.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Anna BuenoTELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2024
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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