366425270-11-17-2022-18-AS-NBRN-CLM2YV-20221128164922

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366425270
Report Date: 11/17/2022
Date Signed: 11/17/2022 03:22:04 PM

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
12/29/2021 and conducted by Evaluator Amber Coleman

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20211229145336

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:	DATE:	11/17/2022
		UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Kevin Villacorte, Assistant Administrator		TIME COMPLETED:	03:20 PM

ALLEGATION(S):

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1.Facility staff did not dispense resident's medication as prescribed.
2.Facility staff did not ensure that resident's medication was refilled in a timely manner
3.Facility failed to transport patient to appointment in order to seek medical 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. S1 informed Administrator Criselda Espiritusanto who later arrived during visit.

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

It is alleged that facility staff did not dispense resident's medication as prescribed. LPA Coleman interviewed staff member (S1) Kevin Villacorte and reviewed the resident's records. According to the the facility's Medication Administration Record (MARS), R1 received all of her medications as prescribed. There is no evidence illustrating medication was missed.

***Please see LIC9099-C***

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amber Coleman	TELEPHONE: 951-248-0338
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022

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 18-AS-20211229145336

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: ABRIA DEL CIELO	FACILITY NUMBER: 366425270
	VISIT DATE: 11/17/2022

NARRATIVE

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Portable oxygen tanks are stored in a secure location safety purposes. When resident's would like to leave for outings, they can ask staff for their portable oxygen tanks. On 12/22/21, R1 was scheduled for an outing and discovered that her portable oxygen machine was malfunctioning. The facility loaned R1 another machine to use while waiting for a replacement. Also, R1 utilizes both a portable oxygen tank as well as a concentrator. The concentrator is kept in resident's rooms. R1 was never without oxygen.

It's alleged that facility staff did not ensure that resident's medication was refilled in a timely manner. According to S1 and S2 interviews, 12/22/22 the facility received a phone call from a responsible party inquiring about medication refills. Administrator reviewed records and discovered that R1 was not out of medications at all. The medication is dispensed by Medication Technicians who are responsible for ordering medications. Once the order is placed, medications are delivered by the pharmacy every Tuesdays. The MARS also indicated when medications are ordered and delivered. All prescribed medications are accounted for.

It is alleged that the facility failed to transport patient to appointment in order to seek medical care. Interview with S1 revealed that the facility does provide transportation services to residents; Monday to Friday 9am to 5pm. Resident's provide their appointment information to staff and staff sign them up on a calendar. If transportation is not available for a specific date, staff will coordinate transport with IEHP. Lastly, if that falls through staff will contact resident's support system for assistance with transport. Review of the event calendar reveled that in months December 2021 to January 2022, R1 had 6 appointments. scheduled. Of the 6 appointments, resident attended 5 appointments. Furthermore, the transportation services are currently being used by R1.

We have found the compliant allegation is unsubstantiated, although the allegation may have happened or is valid; there is not a preponderance of evidence to prove that the alleged violation occurred. A copy of this report is being reviewed with and furnished to the facility representative.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amber Coleman	TELEPHONE: 951-248-0338
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022

LIC9099 (FAS) - (06/04)

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