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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366426683
Report Date: 07/07/2025
Date Signed: 07/07/2025 01:22:13 PM

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
12/13/2024 and conducted by Evaluator Renese Howell-Small
COMPLAINT CONTROL NUMBER: 56-AS-20241213143323
FACILITY NAME:JOHN A. CUTSHALL ARFFACILITY NUMBER:
366426683
ADMINISTRATOR:CUTSHALL, JOHN A.FACILITY TYPE:
735
ADDRESS:13450 BRAMBLE LN.TELEPHONE:
(760) 596-1941
CITY:VICTORVILLESTATE: CAZIP CODE:
92394
CAPACITY:5CENSUS: 2DATE:
07/07/2025
UNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Toni CutshallTIME COMPLETED:
01:25 PM
ALLEGATION(S):
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Staff retained a resident with a prohibited health condition
Staff did not ensure resident’s medical needs were met in a timely manner
Staff did not provide meals to resident in care
Staff did not ensure resident in care was kept hydrated
INVESTIGATION FINDINGS:
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On 07/07/2025 at 12:40PM Licensing Program Analyst (LPA) Renese Howell-Small conducted an unannounced visit to the facility to deliver complaint investigation findings for the above allegations. LPA introduced self, stated the purpose of the visit and met with Administrator, Toni Cutshall. The investigation consisted of record review and interviews.

The allegation of staff retained a resident with a prohibited health condition
The Physician’s Report for Resident 1 (R1) dated 07/23/2024 indicates that R1 was ambulatory and could perform Activities of Daily Living (ADL) independently. R1 was admitted to St. Mary’s hospital on 09/10/2024 for a red and swollen finger. On 09/18/2024 R1 was discharged from St. Mary’s hospital to a Skilled Nursing Facility (SNF) to have antibiotics administered. R1 returned to the facility on 11/27/2024. However, staff observed that R1 had a loss of appetite, refused water and other fluids and had difficulty ambulating. On 11/29/2025 the relatives of R1 took R1 to the hospital, where R1 was admitted. Therefore, this allegation is UNSUBSTANTIATED.


Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Renese Howell-Small
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2025
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-20241213143323
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: JOHN A. CUTSHALL ARF
FACILITY NUMBER: 366426683
VISIT DATE: 07/07/2025
NARRATIVE
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The allegation of staff did not ensure resident’s medical needs were met in a timely manner
On 09/09/2024 Administrator, Toni Cutshall (S2) noticed that Resident 1’s (R1) finger was red and swollen. R1 was taken to St. Mary’s Urgent Care on 09/09/2024, prescribed antibiotics and was sent home with instructions to the staff to return if the condition changed. On 09/10/2024 staff observed R1’s finger had a change in color, was more swollen and staff took R1 to St. Mary’s Emergency Room.

Staff and the relatives of R1 stated that R1 had a habit of biting their fingers due to dental issues. When staff observed R1’s finger to be red and swollen, R1 was taken to urgent care, the following day to the emergency room as instructed. Therefore, this allegation is UNSUBSTANTIATED

The allegation that staff did not provide meals to resident in care

On 12/16/2024 during the initial complaint investigation, LPA observed a fully stocked pantry, refrigerator and freezer with snacks, a variety of perishables and non-perishable food items. S2 stated that the facility shops weekly for groceries and that R1 had always been a good eater. When R1 returned to the facility on 11/27/2024, staff observed that R1 did not have an appetite and refused to eat. Staff continued to offer R1 water, chicken broth, snacks, breakfast, lunch and dinner but R1 did not want to eat. Staff documented in the facility’s care notes that R1 did not eat lunch at the SNF earlier that day. Therefore, this allegation is UNSUBSTANTIATED.

The allegation that staff did not ensure resident in care was kept hydrated

On 12/16/2024 during the initial complaint investigation, LPA observed an operational water filtration device on the facility’s refrigerator, an adequate amount of bottled water and an assortment of refillable water bottles in the kitchen cabinet. On 11/26/2024 S2 visited R1 at the SNF and noted in R1’s care notes that R1’s lips appeared to be dry. When R1 returned to the facility on 11/27/2024 staff repeatedly offered R1 water, Ensure and chicken broth and R1 drank very little or would refuse. Therefore, this allegation is UNSUBSTANTIATED.

An UNSUBSTANTIATED complaint finding is defined as the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.



An exit interview was conducted where this report LIC9099 and LIC9099C were discussed and copy provided to Administrator, Toni Cutshall.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Renese Howell-Small
LICENSING EVALUATOR SIGNATURE:

DATE: 07/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2