366425270-11-17-2022-56-AS-NBRN-CMHUAW-20221227142522

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366425270
Report Date: 11/17/2022
Date Signed: 11/17/2022 03:28:55 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
09/12/2022 and conducted by Evaluator Anna Bueno

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20220912152449

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: 131	DATE:	11/17/2022
		UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Kevin Villacorte		TIME COMPLETED:	03:32 PM

ALLEGATION(S):

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Resident was sexually abused while in care.
Resident was physically abused while in care.
Resident was financially abused while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPAs) Anna Bueno and Amber Coleman conducted an unannounced visit to the facility to conclude the investigation of the above allegations deliver findings. LPAs identified themselves to Kevin Villacorte, assistant administrator, who was notified of the reason for today’s visit. The investigation included staff, witness, and resident interviews, and records review.

Allegation 1: Resident (R1) was sexually abused while in care. It was alleged that R1 was sexually abused by unknown individuals. No details of the abuse were provided, and no further information was obtained from interviews. Interviews conducted deny sexual abuse within the facility by residents and/or by staff. Witnesses confirmed that R1 has confusion and is not a reliable historian. Based on the information obtained, the allegation is unsubstantiated.

Allegation 2: R1 was physically abused while in care. It was alleged that R1 was physically abused by a named individual. R2 and R3 were interviewed and both deny any physical altercation with R1. R2 stated that they do

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: 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 56-AS-20220912152449

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: 11/17/2022

NARRATIVE

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not know R1 while R3 stated a very limited interaction with R1, only within the smoking area. Interviews revealed that there are no witnessed or reported physical assault between residents. Based on information obtained, this allegation is unsubstantiated.

Allegation 3: R1 was financially abused while in care. It was alleged that R1 is being financially abused by another resident (R2). LPA interviewed R2 who denies taking money from R1. LPA was informed by staff that a different resident has been witnessed taking items from other residents, not including R1 or R2, and staff have addressed this concern. Based on obtained information, the allegation is 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 Administrator Criselda Espiritu Santo 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: 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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