366425270-12-23-2024-56-AS-EMAN-DD62RQ-20250121163753

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366425270
Report Date: 12/23/2024
Date Signed: 12/23/2024 03:38:34 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
09/11/2024 and conducted by Evaluator Renese Howell-Small

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20240911113843

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: 143	DATE:	12/23/2024
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Executive Director, Criselda Espiritu Santo		TIME COMPLETED:	03:40 PM

ALLEGATION(S):

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Illegal eviction

INVESTIGATION FINDINGS:

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On 12/23/2024 at 1:30PM Licensing Program Analyst (LPA) Renese Howell-Small conducted an unannounced visit to the facility in order to deliver findings for the above allegation. LPA discussed the purpose of the visit with Executive Director, Criselda Espiritu Santo. The investigation consisted of interviews and record review.

In regards to the allegation of Illegal eviction:
As of 12/23/2024 Resident #1 (R1) is currently living in the facility. Based upon record review, LPA observed that R1 refused assistance with personal care. On 09/12/2024 at 1:47PM, LPA conducted a telephone interview in which R1 confirmed they had refused assistance. LPA observed Resident Shower Logs which confirmed that R1 refused assistance with personal care (19) nineteen times during the months of June-October of 2024.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 836-2748
LICENSING EVALUATOR NAME: Renese Howell-Small	TELEPHONE: (951) 248-2222
LICENSING EVALUATOR SIGNATURE:	DATE: 12/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2024

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-20240911113843

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: 12/23/2024

NARRATIVE

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Staff interviews confirmed that a 30-Day Eviction letter was given to R1 on 09/10/2024 and a copy was received by Community Care Licensing Division (CCLD) which states the reason for R1’s eviction. The facility’s Admission’s Agreement clearly states the Eviction procedures. This Agreement was signed by R1 on 02/02/2023 and is in compliance with Title 22, Division 6 Chapter 8 section 87224.

The allegation is UNSUBSTANTIATED.

UNSUBSTANTIATED is defined as the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted where this report LIC9099 and LIC9099C was discussed and a copy was given to Executive Director, Criselda Espiritu Santo.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 836-2748
LICENSING EVALUATOR NAME: Renese Howell-Small	TELEPHONE: (951) 248-2222
LICENSING EVALUATOR SIGNATURE:	DATE: 12/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2024

LIC9099 (FAS) - (06/04)

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