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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366425270
Report Date: 12/11/2024
Date Signed: 12/11/2024 02:49:18 PM

Document Has Been Signed on 12/11/2024 02:49 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 CIELOFACILITY NUMBER:
366425270
ADMINISTRATOR/
DIRECTOR:		CRISELDA ESPIRITU SANTOFACILITY TYPE:
740
ADDRESS:1589 N. WATERMAN AVETELEPHONE:
(909) 884-4757
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92404
CAPACITY: 240CENSUS: 148DATE:
12/11/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Executive Director Criselda Espiritu SantoTIME VISIT/
INSPECTION COMPLETED:
02:55 PM
NARRATIVE
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On 12/11/2024 at 10;00 AM Licensing Program Analyst (LPA) Melody Brown met with Executive Director (ED) Criselda Espiritu Santo to initiate a case management visit. The investigation consisted of observation, interviews ,and a review of pertinent documentation.

During the facility visit today, 12/11/2024 LPA Brown observed that Staff#8 (S8) does not have the required Food Handlers Training certification. Deficiency will be issued.

An exit interview was conducted where this report (LIC809), LIC809D) and Appeal Rights were discussed and provided to ED Criselda Espiritu Santo.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE: DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/11/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/11/2024 02:49 PM - It Cannot Be Edited


Created By: Melody Brown On 12/11/2024 at 02:18 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

FACILITY NAME: ABRIA DEL CIELO
FACILITY NUMBER: 366425270

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/20/2024
Section Cited
CCR
87555(b)(15)

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87555 General Food Service Requirements
(b( The following food service requiremenst shall apply: (15) All persons engaged in food preparation and service shall observe personnel hygiene and food services sanitation practices...This requirement is not met by as evidence by:
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Licensee stated to submit a copy of S8 Food Handlers Card Training Certification to LPA Brown by the Plan of Correction (POC) due date.
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Based on observation, Interview, and record review ,the licensee didi not comply with the section cited above by not ensuring that Staff#8 (S8) has the required Food Handlers Training Certification which poses a potential health, safety or personal right risk to persons in care.
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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:Efren Malagon
LICENSING EVALUATOR NAME:Melody Brown
LICENSING EVALUATOR SIGNATURE:
DATE: 12/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/11/2024


LIC809 (FAS) - (06/04)
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