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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366413072
Report Date: 08/23/2024
Date Signed: 08/23/2024 04:25:24 PM

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
05/06/2024 and conducted by Evaluator Melody Brown
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240506143154
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: 85DATE:
08/23/2024
UNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Executive Director Kenya CarltonTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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9
Staff are not addressing pests at the facility.
Staff did not communicate with responsible parties regarding residents' care.
INVESTIGATION FINDINGS:
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On 08/23/2024 at 03:45 PM, Licensing Program Analysts (LPAs) Melody Brown, Raquel Hernandez and Renese Howell-Small conducted an unannounced visit to the facility to deliver the findings of the above allegations. LPAs Brown, Hernandez and Small were greeted and granted entrance by a staff member and LPAs Brown, Hernnadez and Small met with Executive Director (ED) Kenya Carlton. LPAs Brown, Hernandez and Howell-Small identified themselves and discussed the purpose of the visit and the elements of the allegations with ED Carlton.

The investigation were conducted by LPAs Melody Brown and Sarina Ramirez. The investigation consisted of observation and interviews with relevant parties. The allegation indicates that Staff are not addressing pests at the facility. During the investigation, LPAs Brown and Ramirez did not find evidence to corroborate the allegation. Interviews with eight (8) of eight (8) residents indicated that staffs are addressing pests at the facility promptly and no incident happened that staffs did not address the pests at the facility. LPAs Brown and Ramirez unable to interview three (3) residents as Resident #2 (R2) was sleeping, Resident #3 (R3) ***Continuation in LIC09099C***
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody BrownTELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2024
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-20240506143154
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: VILLAS AT SAN BERNARDINO
FACILITY NUMBER: 366413072
VISIT DATE: 08/23/2024
NARRATIVE
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was out in the community and Resident #8 (R8) unable to answer LPA Ramirez questions. Interviews with seven (7) of seven (7) staff indicated that they are addressing pests at the facility immediately. Interviews with seven (7) of seven (7) staff indicated that the facility's contracted exterminator were contacted the same day to treat the pests/bed bugs issue at the facility and R1, R2 and R3 were relocated to a different room while the facility's contracted exterminator were treating R1, R2 and R3 for bed bugs issue. During the facility visit on 05/09/2024, LPAs Brown and Ramirez observed that Resident #1 (R1), R2 and R3 rooms showed that the rooms were treated by the facility's contracted exterminators. Per documents review, LPA Brown noted monthly exterminator service invoice at the facility.

The second allegations indicates Staff did not communicate with responsible parties regarding residents' care. Interviews with eight (8) of eight (8) residents indicated that staffs at the facility are communicating their care to their family or responsible party. Interviews with eight (8) of eight (8) residents revealed that staffs at the facility are reporting all incidents to their family or responsible party. LPAs Brown and Ramirez unable to interview three (3) residents as Resident #2 (R2) was sleeping, Resident #3 (R3) was out in the community and Resident #8 (R8) unable to answer LPA Ramirez question. Interviews with seven (7) of seven (7) staffs indicated that staffs at the facility always communicate the care of residents to their family or responsible party and no incident happened at the facility that staffs did not report residents care to their family or responsible party.

Based on the evidence, the allegation that Staff are not addressing pests at the facility (Allegation #1) and Staff did not communicate with responsible parties regarding residents' care (Allegation #2) are UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means 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, therefore the allegation is unsubstantiated at this time.


An exit interview was conducted where this report, LIC9099 was discussed and provided to ED Kenya Carlton.
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody BrownTELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:

DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2