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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366425270
Report Date: 03/27/2024
Date Signed: 03/27/2024 12:26:48 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 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
03/25/2024 and conducted by Evaluator Anna Fannell
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240325123035
FACILITY NAME:ABRIA DEL CIELOFACILITY NUMBER:
366425270
ADMINISTRATOR:CRISELDA ESPIRITU SANTOFACILITY TYPE:
740
ADDRESS:1589 N. WATERMAN AVETELEPHONE:
(909) 884-4757
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92404
CAPACITY:240CENSUS: DATE:
03/27/2024
UNANNOUNCEDTIME BEGAN:
10:34 AM
MET WITH:TIME COMPLETED:
12:28 PM
ALLEGATION(S):
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Facility failed to notify resident authorized representative about medical treatment.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Anna Fannell conducted an unannounced visit to this facility for the purpose of initiating the investigation of and delivering findings for the above allegation. LPA met with Licensee Edna Medrano who was advised of the purpose of visit. Administrator Cris Espiritu Santo arrived during today's visit. The investigation consisted of review of relevant records and interviews with relevant parties.

It is alleged that the Facility failed to notify Resident (R1) authorized representative about medical treatment. LPA reviewed records showing that R1 has a medical power of attorney (POA) agent. Interviews revealed that R1 has been experiencing daily reoccurring nosebleeds that facility staff sent R1 to the local medical facility. Interviews further revealed that R1's representative has been receiving communication from the facility about R1's condition and R1's representative was aware that R1 would leave the local medical facility and return to this residential facility before R1 could receive medical treatment. Staff (S1) interview revealed they arranged for non-medical transport to take R1 to a non local medical facility in an attempt to prevent R1 from leaving the medical facility. This allegation is therefore unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Anna FannellTELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 56-AS-20240325123035
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ABRIA DEL CIELO
FACILITY NUMBER: 366425270
VISIT DATE: 03/27/2024
NARRATIVE
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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 Administrator Espiritu Santo.
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Anna FannellTELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2