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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366425270
Report Date: 12/23/2024
Date Signed: 12/23/2024 03:40:00 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
11/06/2024 and conducted by Evaluator Renese Howell-Small
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20241106121830
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: 143DATE:
12/23/2024
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Execuitve Director, Criselda Espiritu SantoTIME COMPLETED:
03:40 PM
ALLEGATION(S):
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Staff do not prevent resident from being hit by other residents
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 Staff do not prevent resident from being hit by other residents:
Resident #1 (R1) has been moved as of 11/12/2024 to another facility which provides a higher level of care. Based upon record review, LPA observed R1 had mild cognitive impairment. Interviews with staff confirmed that R1was forgetful and often was confused. Interviews with residents confirmed that staff lock the residents' doors at night and residents have their own keys to their assigned rooms. Residents and staff deny witnessing any residents hitting other residents.


Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2748
LICENSING EVALUATOR NAME: Renese Howell-SmallTELEPHONE: (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)
Page: 1 of 2
Control Number 56-AS-20241106121830
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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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 ClemonsTELEPHONE: (951) 836-2748
LICENSING EVALUATOR NAME: Renese Howell-SmallTELEPHONE: (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)
Page: 2 of 2