366425270-8-16-2023-56-AS-NBRN-CUZVS3-20230824164051

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366425270
Report Date: 08/16/2023
Date Signed: 08/16/2023 10:11:59 AM

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
08/08/2023 and conducted by Evaluator Anna Bueno

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230808092638

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: 138	DATE:	08/16/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Edna Medrano - Administrator		TIME COMPLETED:	10:13 AM

ALLEGATION(S):

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Staff violated resident's confidentiality.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced visit to the facility to initiate the complaint investigation and deliver findings on the above allegation. LPA met with licensee Edna Medrano was informed of the purpose of today’s visit. The investigation consisted of inspection of facility plant and staff and resident interviews.

The allegation is Staff violated resident's confidentiality. During today's visit, LPA observed two whiteboards with residents' names, room numbers, dates, and names of facilities behind the medication room counter. LPA did not observe any listed diagnoses. Staff and resident interviews confirm that returning residents will bring their discharge paperwork to the med room and discuss the information with the LVN or med technician. Interviews with staff further reveal that other residents are ushered out of the med room during this process however some residents may choose to stay outside partially closed doors of the med room. 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 and a copy of this report was provided to Mrs.Medrano.

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: 08/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2023

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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