366425270-5-26-2021-18-AS-JESL-C98VZQ-20211129155306

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366425270
Report Date: 05/26/2021
Date Signed: 05/26/2021 06:38:46 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
09/18/2020 and conducted by Evaluator Javina George

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200918102018

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: 160	DATE:	05/26/2021
		UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Administrator MaCriselda Espiritu Santo		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Unlawful eviction
Resident denied food

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Javina George conducted and unannounced visit to the facility for the purpose of delivering findings for the above allegation(s). LPA George met with Administrator MaCriselda Espiritu Santo. Below is a summary of the investigation.
Allegation #1 Unlawful eviction.
LPA George reviewed the eviction notice. The reasons stated for eviction were "verbally abusive with staff and resident, on 9/17/20 Violent behavior which staff and residents feel unsafe". LPA reviewed video footage of resident #1 (R1) destroying the plexi glass in the front lobby, as well as the Administrator's office. R1 also threw objects such as a 3 hole puncher, knocked the printer off of the desk and binders. R1 admitted to LPA during an interview that they had threatened to shoot everyone in the facility and would have done so if they had a gun. LPA interviewed R1 whom admitted that they did do everything as described. Therefore the allegation of unlawful eviction is UNSUBSTANTIATED. A finding that the complaint is 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, therefore the allegation is unsubstantiated at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (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 4

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
09/18/2020 and conducted by Evaluator Javina George

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200918102018

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: 160	DATE:	05/26/2021
		UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Administrator MaCriselda Espiritu Santo		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

1
2
3
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5
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7
8
9

Facility is retaliating against resident
Facility is not transporting resident to doctor appointments

INVESTIGATION FINDINGS:

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2
3
4
5
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7
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9
10
11
12
13

Licensing Program Analyst (LPA) Javina George conducted and unannouced visit to the facility for the purpose of delivering findings for the above allegation(s). LPA George met with Administrator MaCriselda Espiritu Santo. Below is a summary of the investigation.

Allegation # 1 Facility is retaliating against resident
Based on interviews conducted R1 alleges that there is a law suit against the facility. However LPA could not confirm this to be true. R1 could not provide information for the case or attorney that R1 had been in contact with. After multiple conversations it is believed that R1 was referring to the previous facility that they used to reside at in Riverside, CA. To date Administrator has not been informed that there is a law suit against the facility from R1. Other individual's interviewed could not confirm that there has been a situation that they feel that facility staff was/had retaliating against them. The allegation of facility is retaliating against resident is UNFOUNDED.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (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: 3 of 4

Control Number 18-AS-20200918102018

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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A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

Allegation # 2 Facility is not transporting resident to doctor appointments

Feedback provided from interviews R1 had arranged their own transportation for their appointment. Therefore the appointment was not placed on the calendar for the facility driver to transport R1 to their appointment. Interviews conducted, resident's interviewed could only recall appointments being cancelled due to the covid-19 pandemic. Which during that time Doctor's offices were not conducting in person visits and were conducting tele health appointments. The allegation of facility is not transporting resident to doctor appointments is UNFOUNDED. A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

An exit interview was conducted and a copy of this report and 9099C, was provided to Administrator MaCriselda Espiritu Santo.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (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: 05/18/2021

LIC9099 (FAS) - (06/04)

Page: 4 of 4

Control Number 18-AS-20200918102018

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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Allegation # 2 Resident denied food

LPA George interviewed R1. During the interview R1 stated that they had arranged for transportation for their medical appointment and that they would not be at the facility for lunch. R1 stated when they approached the front desk that staff was on the phone, they had made their request and was waiting. Administrator Criselda whom was also present stated that the request had been made by staff when R1 became upset and started calling staff "screwballs", and proceeded to destroy property in the lobby. Due to the behavioral episode there was a delay in staff being able to retrieve R1s requested lunch. The allegation of resident denied food is UNSUBSTANTIATED. A finding that the complaint is 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, therefore the allegation is unsubstantiated at this time.

An exit interview was conducted and a copy of this report, and 9099C was provided to Administrator

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (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 4