366426338-2-20-2026-56-AS-EMAN-DRLPEJ-20260224101514

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366426338
Report Date: 02/20/2026
Date Signed: 02/20/2026 10:12:30 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
11/07/2025 and conducted by Evaluator Paola Guerrero

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20251107091354

FACILITY NAME:	OAKMONT OF SAN ANTONIO HEIGHTS		FACILITY NUMBER:	366426338
ADMINISTRATOR:	SAMUEL DE GUZMAN		FACILITY TYPE:	740
ADDRESS:	2419 N EUCLID AVE		TELEPHONE:	(909) 981-4002
CITY:	UPLAND	STATE: CA	ZIP CODE:	91786
CAPACITY:	140	CENSUS: 82	DATE:	02/20/2026
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Brandy Herrera		TIME COMPLETED:	10:15 AM

ALLEGATION(S):

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Staff did not provide adequate supervision, resulting in resident sustaining a fracture

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Paola Guerrero arrived at the facility to deliver investigative findings. LPA met with Facility Health Services Director and explained the purpose of the visit regarding the allegations listed above.

First allegation: Staff did not provide adequate supervision, resulting in resident sustaining a fracture. Regarding the allegation stated above, LPA conducted a review of records pertaining to Resident #1 throughout the review of records LPA discovered that Resident #1 was not classified as a fall-risk. In addition, throughout record review LPA discovered that during Resident #1 fall Resident #1 was assisting Resident 2 in the shower and due to the assistance Resident #1 was providing to Resident #2 led Resident #1 to sustain a fall which resulted in Resident #1 to sustain an elbow fracture. During review of records LPA discovered that Resident # 1 did not have a history of frequent falls. LPA conducted an interview with Facility Health Services Director who informed LPA that the facility had Reported to Resident #1 and resident’s family, about the concerns regarding Resident #1 providing care to Resident #2.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2026

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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Control Number 56-AS-20251107091354

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: OAKMONT OF SAN ANTONIO HEIGHTS	FACILITY NUMBER: 366426338
	VISIT DATE: 02/20/2026

NARRATIVE

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Health Services Director informed LPA that Resident #1 was informed by the staff and the family not to assist Resident #2 with care. LPA conducted an interview with Resident #1 responsible party which they informed that Resident #1 was aware not to be providing care to Resident #2, and the result of that fracture was due to Resident # 1 not asking staff for assistance and continuing to provide care to Resident #2. Based on corroborating evidence the department has determined that the above allegations are Unsubstantiated, meaning 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 (LIC 9099) was discussed, and a copy was provided to Facility Administrator

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2026

LIC9099 (FAS) - (06/04)

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