366425270-7-11-2024-56-AS-EMAN-D7ASEZ-20240718134935

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366425270
Report Date: 07/11/2024
Date Signed: 07/11/2024 10:54:31 AM

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
04/15/2024 and conducted by Evaluator Paola Guerrero

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20240415102056

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: 129	DATE:	07/11/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Norma Villacis-Facility LVN		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Staff physically assaulted resident resulted in injuries
Staff verbally abused resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Facility LVN Norma Villacis and explained the purpose of the visit. The investigation consisted of interviews and review of records.

First allegation, Staff physically assaulted resident resulted in injuries. LPA conducted interviews with resident[s] pertaining to the allegation “staff physically assaulted resident resulted in injuries” all residents denied being physically assaulted by staff in addition, all residents denied witnessing staff physically assault residents in care. During interviews Resident (R#1), stated not remembering how bruise was obtained and denied bruise being caused by staff. LPA conducted interviews with staff pertaining to the alleged allegation and all staff denied physically assaulting resident along with witnessing staff physically assault resident in care.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Paola Guerrero	TELEPHONE: (951) 473-7024
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024

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-20240415102056

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: 07/11/2024

NARRATIVE

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Second allegation, Staff verbally abused resident. LPA conducted interviews with resident[s] pertaining to the allegation “staff verbally abused resident” during interviews with residents 4 out of 5 residents denied being verbally abused by staff in addition, four out of five residents also denied witnessing staff verbally abuse resident. LPA conducted interviews with staff and all staff denied verbally abusing resident along with witnessing staff verbally abuse resident[s] in care. Based on corroborating evidence obtained during the course of the investigation, LPA has determined that the above allegations are Unsubstantiated.

Unsubstantiated; meaning that 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 where this report (LIC 9099) was discussed, and a copy was provided to Facility LVN Norma Villacis.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Paola Guerrero	TELEPHONE: (951) 473-7024
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2024

LIC9099 (FAS) - (06/04)

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