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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366425270
Report Date: 12/07/2023
Date Signed: 12/07/2023 12:38:42 PM

Unsubstantiated


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
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/30/2023 and conducted by Evaluator Anna Bueno
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20231130160801
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: DATE:
12/07/2023
UNANNOUNCEDTIME BEGAN:
10:04 AM
MET WITH:Cris Espiritu SantoTIME COMPLETED:
12:42 PM
ALLEGATION(S):
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Staff does not assist resident with transfers from bed to wheelchair.
Staff does not give resident any medications for the past 2 years.
Staff is attempting to become resident's payee for social security.
Staff become resident's POA without resident's consent.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Anna Bueno and Javier Prieto conducted an unannounced visit to the facility to initiate the complaint investigation and deliver findings on the above allegation. LPAs met with administrator Criselda Espiritu Santo was informed of the purpose of today’s visit. The investigation consisted of a review of relevant records and staff interviews. LPAs were unable to contact Resident (R1).

Allegation 1: Staff does not assist R1 with transfers from bed to wheelchair. LPAs reviewed R1's assesment from 10/31/23 conducted by a third-party showing that R1 requires limited assistance in making transfers and would like to be more independent in making their own transfers. Staff interviews revealed that R1 is able to transfer independently. This allegation is unsubstantiated.

Allegation 2: Staff does not give resident any medications for the past 2 years. LPAs reviewed records showing that R1 has refused services from the facility, including, medication administration, going to medical appointments, and checking their blood pressure. Records revealed that R1's refusal has been consistent since August 2023. Interviews with staff confirmed that R1 has refused to take their medication for months. This allegation is therefore unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023
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-20231130160801
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
, CA 92507
FACILITY NAME: ABRIA DEL CIELO
FACILITY NUMBER: 366425270
VISIT DATE: 12/07/2023
NARRATIVE
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Allegation 3: Staff is attempting to become resident's payee for social security; AND
Allegation 4: Staff become resident's POA without resident's consent.
LPAs interviewed witness who shared that during a 10/31/23 meeting with R1, they did not disclose facility staff has attempted to become R1's payee or to have authority over R1 by filing a Power of Attorney (POA). LPAs reviewed records showing that R1 is capable of making their own decisions but may need reminders. Interviews with administrator deny that the facility attempted to become R1's payee nor has the facility filed POA over R1. Administrator further added R1 is capable of going out in the community on their own using their walking assistive device. These allegations are therefore unsubstantiated.

A finding of 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. An exit interview was conducted with and a copy of this report was provided to Administrator Espiritu Santo.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2