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ICF/DD-H (Habilitative)License activeMedi-Cal certified

SAN BERNARDINO HOUSE

ICF/DD-H (Habilitative) · 6 licensed beds · Pomona, CA

Homes of 4–15 beds for people with developmental disabilities whose nursing needs are intermittent and predictable.

Address

SAN BERNARDINO HOUSE692 SAN BERNARDINO AVEPomona, CA 91767 · Los Angeles County

Phone: (951) 858-8637

Facility details

CDPH listing, data as of Oct 16, 2026
Facility type
ICF/DD-H (Habilitative)
Licensed beds
6
Licensee
ALPHA RESIDENTIAL, INC. · Profit Corp
CDPH facility ID
630014300
License number
550002479
First licensed
November 5, 2013
Current license
Jun 1, 2026 to May 31, 2027
CDPH district office
La Icf/Dd/Clinics

Federal certification (CMS)

CMS Provider of Services file
CMS Certification Number (CCN)
55G740
Status in CDPH's listing
Licensed And Certified
Program
Medi-Cal (Medicaid, Title XIX)
Participating since
June 28, 2016
Last certification survey
January 23, 2026
CMS certification status
Certified
In compliance (CMS)
Yes
Last certification action
Recertification
Ownership type (CMS)
Private (proprietary)
Certified beds (CMS)
6
Staffing reported to CMS
RN 1 · LVN/LPN 0 · direct care 8 · all employees 9

State citations and penalties (CDPH)

CDPH issues citations under Health and Safety Code §1424: Class AA (a violation that was a substantial factor in a resident's death), Class A (imminent danger or a substantial probability of death or serious harm) and Class B (a direct relationship to residents' health, safety or security). State citations explained

No state citations or penalties on record for this facility in CDPH's enforcement data (July 1998 to date).

Federal inspections (CMS-2567)

24 surveys since 2018 · CMS data through Oct 12, 2026

CDPH surveys certified ICFs for CMS. Each deficiency is a W-tag (a federal ICF/IID requirement), an E-tag (emergency preparedness) or a K-tag (Life Safety Code), cited at the standard level or, more seriously, the condition level. How to read an ICF inspection

Content note: these federal findings describe residents' care and can include abuse, neglect, injuries and medical details. They're shown as CMS published them; residents are identified only by number (such as "Client 1").

  1. · Recertification

    Event KO2Z21 · 3 deficiencies

    Official 2567 ↗
  2. · Recertification

    Event KO2Z11 · 1 deficiency

    Official 2567 ↗
  3. · Recertification

    Event O3AX21 · 7 deficiencies

    Official 2567 ↗
  4. · Recertification

    Event O3AX11 · 5 deficiencies

    Official 2567 ↗
  5. · Recertification

    Event 3N5X21 · 7 deficiencies

    Official 2567 ↗
  6. · Recertification

    Event 3N5X11 · 5 deficiencies

    Official 2567 ↗
  7. · Complaint

    Event USJU11 · no deficiencies cited

    Official 2567 ↗
  8. · Complaint

    Event 1LKM11 · no deficiencies cited

    Official 2567 ↗
  9. · Recertification

    Event UFN521 · 12 deficiencies

    Official 2567 ↗
  10. · Recertification

    Event UFN511 · 3 deficiencies

    Official 2567 ↗
  11. · Complaint

    Event 4SLR11 · no deficiencies cited

    Official 2567 ↗
  12. · Recertification

    Event UR6Z21 · 1 deficiency

    Official 2567 ↗

From CMS's QCOR ICF/IID statement-of-deficiency download, saved Oct 26, 2026. CMS notes that ICF/IID data after March 19, 2026 may be incomplete while its systems migrate. Plans of correction and state-only (licensing) deficiencies aren't in that file; the official 2567 documents on CalHealthFind have them.

Complaints and reported incidents

CDPH doesn't publish complaints or facility-reported incidents as a bulk file, so they aren't on ICFLookup. Its CalHealthFind page for this facility lists them (intake date, allegation category and whether each was substantiated), along with state licensing deficiencies and ownership details.

Federal surveys that came from a complaint or an incident report do appear above, marked "Complaint" as the survey type.

Open this facility on CalHealthFind ↗How to file a complaint with CDPH

Change history

25 events, newest first

Dates marked "state record" are the agencies' own: the license date, federal survey dates and penalty issue dates. "Detected" changes are ones we noticed by comparing CDPH's monthly facility listing with the one before it, tracked since Oct 26, 2026.

  1. ReportFederal survey (recertification): 3 deficiencies(state record)

    See this survey →
  2. ReportFederal survey (recertification): 1 deficiency(state record)

    See this survey →
  3. ReportFederal survey (recertification): 7 deficiencies(state record)

    See this survey →
  4. ReportFederal survey (recertification): 5 deficiencies(state record)

    See this survey →
  5. ReportFederal survey (recertification): 7 deficiencies(state record)

    See this survey →
  6. ReportFederal survey (recertification): 5 deficiencies(state record)

    See this survey →
  7. ReportFederal survey (complaint): no deficiencies(state record)

    See this survey →
  8. ReportFederal survey (complaint): no deficiencies(state record)

    See this survey →
  9. ReportFederal survey (recertification): 12 deficiencies(state record)

    See this survey →
  10. ReportFederal survey (recertification): 3 deficiencies(state record)

    See this survey →

Sources: CDPH Licensed and Certified Healthcare Facility Listing (data as of Oct 16, 2026), CDPH State Enforcement Actions, and CMS's ICF/IID statement-of-deficiency (CMS-2567) and Provider of Services files. ICFLookup is not affiliated with CDPH or CMS; always confirm with CDPH's CalHealthFind ↗ before making a decision. See How our data works.