366425270-7-17-2023-56-AS-NBRN-CTXTB6-20230721143437

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366425270
Report Date: 07/17/2023
Date Signed: 07/17/2023 01:47:54 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
06/27/2023 and conducted by Evaluator Anna Bueno

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230627125026

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: 147	DATE:	07/17/2023
		UNANNOUNCED	TIME BEGAN:	09:42 AM
MET WITH:	Kevin Villacorte		TIME COMPLETED:	01:50 PM

ALLEGATION(S):

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Financial abuse
Staff did not send medication with resident when resident moved
Facility has bed bugs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced subsequent visit to the facility to continue the complaint investigation and deliver findings on the above allegations. LPA met with assistant administrator Kevin Villacorte who was informed of the purpose of today’s visit. The investigation consisted of interviews with relevant parties, observations of the facility, and review of relevant records.

Allegation 1: Financial Abuse. It was alleged that a total of $3009.00 was withdrawn from R1's government benefit account without permission. LPA reviewed records showing that R1 was admitted to the facility on 2/23/2023 and was discharged on 5/3/2023. Records reviewed show that R1 has an out of state ID and did not poses any government benefits card when they were released from a medical facility to this assisted living facility. Staff interview reveal that while the facility assisted R1 in obtaining their government ID and benefits, R1 did not want facility staff involved with their finances. Witness interview revealed that they were assisting R1 with relocation. LPA reviewed a facility receipt of $3000 from R1 for their board and care payment from 2/23/23 through 5/3/23. This allegation is therefore unsubstantiated.

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: 07/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2023

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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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
06/27/2023 and conducted by Evaluator Anna Bueno

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230627125026

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: 147	DATE:	07/17/2023
		UNANNOUNCED	TIME BEGAN:	09:42 AM
MET WITH:			TIME COMPLETED:	01:50 PM

ALLEGATION(S):

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Staff did not provide requested records to resident's representative

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced subsequent visit to the facility to continue the complaint investigation and deliver findings on the above allegation. LPA met with assistant administrator Kevin Villacorte who was informed of the purpose of today’s visit. The investigation consisted of staff interviews and records review.

It is alleged that facilty Staff did not provide requested records to resident's (R1) representative. Staff interviews deny that R1 had a representative but had an emergency contact. LPA reviewed facility records and medical discharge records and found that R1 is self responsible. LPA did not find evidence of R1 having any assigned Power of Attorney (POA), medical or otherwise, while under this facility's care.

This agency has investigated the complaint allegation. We have found that the complaint was unfounded meaning that the allegation was false, could not have happened and/or is without a reasonable basis. No deficiencies were cited during the visit. An exit interview was conducted with administrator May Cabrera and a copy of this report was provided to Administrator.

Unfounded

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: 07/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 56-AS-20230627125026

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: 07/17/2023

NARRATIVE

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Allegation 2: Staff did not send medication with resident when resident moved. LPA reviewed records that R1 was discharged from the facility to their county health specialist with a one week supply of medication and all of R1's personal items. Staff interviews revealed that R1's county health specialist arranged for R1's departure from the facility and that R1 was not transported by the facility. Witness interview deny that they assisted R1 in transportation as R1 refused assistance from the witness. This allegation is unsubstantiated.

Allegation 3: Facility has bed bugs. LPA inspected rooms in the facility, including rooms previously occupied by R1, and did not find any evidence of bed bugs and found resident mattresses secured with waterproof pads. Resident interviews deny presence of bed bugs. Staff interviews reveal that the facility has not had reports of bed bugs since the issue was addressed approximately three years ago. LPA reviewed records confirming that the facility has a monthly pest control service. Pest control records further reveal absence of bed bugs. This allegation is therefore 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 MAy Cabrera and a copy of this report was provided to Administrator.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Anna Bueno	TELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:	DATE: 07/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2023

LIC9099 (FAS) - (06/04)

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