366425270-10-24-2022-56-AS-NBRN-CLLUPT-20221128144602

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366425270
Report Date: 10/24/2022
Date Signed: 10/24/2022 03:40:11 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
10/21/2022 and conducted by Evaluator Anna Bueno

COMPLAINT CONTROL NUMBER: 56-AS-20221021081347

FACILITY NAME:	ABRIA DEL CIELO		FACILITY NUMBER:	366425270
ADMINISTRATOR:	CRISELDA ESPIRITU SANTO		FACILITY TYPE:	740
ADDRESS:	1589 N. WATERMAN AVE		TELEPHONE:	(909) 884-4757
CITY:	SAN BERNARDINO	STATE: CA	ZIP CODE:	92404
CAPACITY:	240	CENSUS: 133	DATE:	10/24/2022
		UNANNOUNCED	TIME BEGAN:	01:25 PM
MET WITH:	Kevin Villacorte		TIME COMPLETED:	03:40 PM

ALLEGATION(S):

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1. Staff did not ensure resident attended medical appointment.
2. Staff did not transportation to residents in care.

INVESTIGATION FINDINGS:

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LPA Amber Coleman (LPA Coleman) and LPA Anna Bueno (LPA Bueno) arrived at the Abria De Cielo for an unannounced visit to initiate a complaint investigation and deliver finding. LPA's met with Assistant. Manager. Kevin Villacorte (S1), who made introductions and discussed the purpose of the visit.

The investigation included LPA's Coleman and Bueno, records review, staff and resident (R1) interviews.

Allegation #1 & #2: It is alleged that staff do not provide transportation services and staff do not ensure the residents attended medical appointment. Interview with Staff 1 revealed that the client manages their own medical appointments. It was reported that the driver may not escort the clients inside the appointment. however they provide a resident information sheet to the medical staff inside. Records review revealed that the client has resided in the facility for over 2 years and has been utilizing the facility's transportation services up to 3 times a week. Records also revealed that the resident.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Anna Bueno	TELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2022

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-20221021081347

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: ABRIA DEL CIELO	FACILITY NUMBER: 366425270
	VISIT DATE: 10/24/2022

NARRATIVE

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has been consistently administered medication for their ongoing diagnosis. S1 denies that there has been any issues with the client and the transportation services. The facility provides transportation and arranges for a 3rd party transportation services. On October 19th, 2022, Facility's Transportation Calendar displayed that transportation was provided for 8 residents including R1, with appointments between 9:45am to 1:30pm.

Based on information above, these allegations are UNSUBSTANTIATED
A finding of 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.

An exit interview was conducted with Kevin Villacorte and a copy of this report was provided.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Anna Bueno	TELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2022

LIC9099 (FAS) - (06/04)

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