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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366425568
Report Date: 02/05/2026
Date Signed: 02/05/2026 11:01:47 AM

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
03/13/2025 and conducted by Evaluator Sarina Ramirez
COMPLAINT CONTROL NUMBER: 56-AS-20250313143700
FACILITY NAME:PACIFIC PINESFACILITY NUMBER:
366425568
ADMINISTRATOR:AMANDA SANTOSFACILITY TYPE:
740
ADDRESS:1438 PACIFIC ST.TELEPHONE:
(909) 801-1911
CITY:REDLANDSSTATE: CAZIP CODE:
92373
CAPACITY:14CENSUS: DATE:
02/05/2026
UNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:House Manager Annaliza LazoTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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9
Resident in care was diagnosed with severe dehydration.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Sarina Ramirez and Andrew Martinez conducted an unannounced visit to deliver findings on the allegations mentioned. LPAs met with House Manager Annaliza Lazo and explained the purpose of the visit. The Department's investigation involved interviews and records review.

It is alleged a resident in care was diagnosed with severe dehydration. The medical records confirm that Resident #1 (R1) was dehydrated but also show consistent communication among the facility administrator, R1’s family, and hospital staff. Over the span of two years of R1’s stay at the facility, both family members and staff report R1 has consistently received good care, including adequate food and hydration. A family member responsible for overseeing R1’s medical needs stated that relatives visit frequently, often weekly or daily to ensure R1’s well being and affirmed that staff provide attentive care. Medical professionals did not attribute her dehydration to facility neglect. Based on the available information, there is insufficient evidence to conclude that R1’s hospitalization for dehydration resulted from neglect or lack of supervision. The allegation is therefore deemed unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2026
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 4
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
03/13/2025 and conducted by Evaluator Sarina Ramirez
COMPLAINT CONTROL NUMBER: 56-AS-20250313143700

FACILITY NAME:PACIFIC PINESFACILITY NUMBER:
366425568
ADMINISTRATOR:AMANDA SANTOSFACILITY TYPE:
740
ADDRESS:1438 PACIFIC ST.TELEPHONE:
(909) 801-1911
CITY:REDLANDSSTATE: CAZIP CODE:
92373
CAPACITY:14CENSUS: DATE:
02/05/2026
UNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:TIME COMPLETED:
11:15 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not seek medical attention for resident.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs) Sarina Ramirez and Andrew Martinez conducted an unannounced visit to deliver findings on the allegations mentioned. LPA met with House Manager Annaliza Lazo and explained the purpose of the visit. The Department's investigation involved interviews and records review.

It is alleged that staff did not seek medical attention for a resident (R1). Facility documentation and medical records reviewed do not support the claim that R1 did not receive timely medical care. The records reflect consistent communication between the facility administrator, R1’s family, and hospital staff. On February 12, 2025, medical personnel notified the facility that R1 required a higher level of care and should be transported to the Emergency Department. Facility staff immediately called 9 1 1, and R1 was transported by ambulance the same day. Given the reporting party’s recanted statement, interviews with staff and family, and the corroborating medical documentation, there is no evidence that staff neglected to provide timely medical attention to R1. The allegation is therefore unfounded.

Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 56-AS-20250313143700
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: PACIFIC PINES
FACILITY NUMBER: 366425568
VISIT DATE: 02/05/2026
NARRATIVE
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Based on lack of evidence, Departments observations, and interviews, the allegation above is Unfounded. A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

An exit interview was conducted with House Manager Annaliza Lazo, and a copy of this report was provided at the conclusion of the visit.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 56-AS-20250313143700
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: PACIFIC PINES
FACILITY NUMBER: 366425568
VISIT DATE: 02/05/2026
NARRATIVE
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Based on Departments observations, staff and resident interviews, and relevant documentation, the allegation is determined to be Unsubstantiated. An Unsubstantiated finding means that although the allegations may be valid or could have occurred, there is insufficient evidence to support that the alleged violations did or did not happen.

An exit interview was conducted with House Manager Annaliza Lazo, and a copy of this report was provided at the conclusion of the visit.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4