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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366425270
Report Date: 05/26/2021
Date Signed: 05/26/2021 02:49:15 PM



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
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/16/2020 and conducted by Evaluator Javina George
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20200616144901
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: 160DATE:
05/26/2021
UNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Administrator MaCriselda Espiritu SantoTIME COMPLETED:
12:40 PM
ALLEGATION(S):
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Facility staff did not meet residents medical needs.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javina George called the facility for the purpose of delivering findings for the above allegation(s). LPA George met with Administrator MaCriselda Espritu Santo and advised the purpose of visit. Below is a summary of the findings of the investigation:
The above complaint was investigated by the department. The investigation consisted of interviews of numerous individuals connected to the facility as well as obtaining documentation that includes: protocol for appointments including the appointment calendar and staff schedule, and a review of the facility's complaint history.

Based on a review of information gathered from documentation, and conducted interviews. LPA George was able to corroborate the allegation.
*Continued on 9099C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2021
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 3
Control Number 18-AS-20200616144901
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
RIVERSIDE, CA 92507
FACILITY NAME: ABRIA DEL CIELO
FACILITY NUMBER: 366425270
VISIT DATE: 05/26/2021
NARRATIVE
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LPA George observed that more than 3 individuals interviewed had knowledge of a resident having to have missed their appointment due to being taken to the wrong address. It was explained that there was a misunderstanding and that the person responsible for verifying that the information was correct had not done so, and defined the missed appointment as miscommunication.

The above allegation of Facility staff did not meet residents medical needs is SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met.

An exit interview was conducted and a copy of this report, 9099D, and appeal rights was provided to Administrator MaCriselda Espiritu-Santo.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20200616144901
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
RIVERSIDE, CA 92507

FACILITY NAME: ABRIA DEL CIELO
FACILITY NUMBER: 366425270
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/26/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/09/2021
Section Cited
HSC
87465(a)(1)
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87465 Incidental Medical and Dental care
(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and for assistance in obtaining such care, by compliance with the following: The licensee shall provide assistance in meeting necessary medical and dental needs. This includes transportation... which will meet the resident's need. In providing transportation the licensee shall do so directly or make arrangements for this service. This requirement is not by: Licensee failed to comply on 1 out of 1 times. This poses a potential health, safety or personal rights risk to persons in care.
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The licensee agrees have all staff retrained on their job duties and expectations, including reviewing their current job descriptions. The training should include resident rights. Staff training needs to be submitted to the department by 5pm on the due date indicated.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3