306000347-9-21-2023-22-AS-SSAS-CW4QG3-20230928120853

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306000347
Report Date: 09/21/2023
Date Signed: 09/21/2023 01:48:51 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/13/2023 and conducted by Evaluator Joseph Alejandre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230913081439

FACILITY NAME:	ATRIA SAN JUAN		FACILITY NUMBER:	306000347
ADMINISTRATOR:	JAMES CRADDOCK		FACILITY TYPE:	740
ADDRESS:	32353 SAN JUAN CREEK RD		TELEPHONE:	(949) 661-1220
CITY:	SAN JUAN CAPISTRANO	STATE: CA	ZIP CODE:	92675
CAPACITY:	140	CENSUS: 77	DATE:	09/21/2023
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Sabrina Priesman, Cyndi Schrock		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Illegal eviction
Facility is not honoring admission agreement

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegations listed above. LPA met with Executive Director (ED) Sabrina Priesman and explained the reason for the visit. The investigation into the allegation, illegal eviction, revealed the following. It was reported that Resident 1 (R1) was being evicted by the facility, and the responsible party was told they must move R1 out of the facility. The Executive Director reported that no eviction notice was ever sent to R1 or their responsible party and no one was told they must move out of the facility. The Executive Director reported that R1's responsible party was informed that if they were not happy with the facility they could move out. R1's responsible party verified this information. R1 reported that no one has told them to move or provided them with an eviction notice. R1's responsible party reported they never received an eviction notice. There is no evidence to support the allegation. Based on the evidence gathered the allegation is Unfounded, meaning the allegation is false could not have happened and/or is without a reasonable basis.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023

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 4

Control Number 22-AS-20230913081439

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: ATRIA SAN JUAN	FACILITY NUMBER: 306000347
	VISIT DATE: 09/21/2023

NARRATIVE

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Regarding the allegation, facility is not honoring admission agreement, the investigation revealed the following. It was reported that the facility would not provide a reassessment after Resident 1 (R1) moved into the facility. The Executive Director reported that the facility reassessed R1 on 9/20/23. A review of records shows that R1 was reassessed on 9/20/23 within 30 days of R1's move in date as specified in the admission agreement. Based on the evidence gathered the allegation, is Unfounded, meaning the allegation is false could not have happened and/or is without a reasonable basis. An exit interview was conducted and a copy of the report provided.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023

LIC9099 (FAS) - (06/04)

Page: 2 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/13/2023 and conducted by Evaluator Joseph Alejandre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230913081439

FACILITY NAME:	ATRIA SAN JUAN		FACILITY NUMBER:	306000347
ADMINISTRATOR:	JAMES CRADDOCK		FACILITY TYPE:	740
ADDRESS:	32353 SAN JUAN CREEK RD		TELEPHONE:	(949) 661-1220
CITY:	SAN JUAN CAPISTRANO	STATE: CA	ZIP CODE:	92675
CAPACITY:	140	CENSUS: 77	DATE:	09/21/2023
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Sabrina Priesman, Cyndi Schrock		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff failed to administer medication as prescribed

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegation listed above. LPA met with Executive Director Sabrina Priesman and explained the reason for the visit. The investigation into the allegaiton, staff failed to administer medication as prescribed revealed the following. It was reported that the facility did not administer all of the medication Resident 1 (R1) was prescribed. R1's responsible party reported that they are not aware of any medication issues regarding R1's medication being administered. Staff interviewed reported that R1's medication has been administered as prescribed. R1 moved into the facility on 9/4/23. A review of R1's medication administration records (MAR) shows that R1's medication was administered starting on 9/19/23. Facility records show a Centrally Stored Medication and Destruction Record LIC 622 (CSMDR) was completed by facility staff dated 9/7/23. The Executive Director reported that R1 was put in the MAR system based on the refill date of R1's prescriptions and the system doesn't allow for entries until the prescriptions are refilled through a pharmacy recognized in the system. The ED reported that until the system allows for entries staff utilize the CSMDR LIC 622. Facility staff reported all R1's medications have been

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023

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 22-AS-20230913081439

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: ATRIA SAN JUAN	FACILITY NUMBER: 306000347
	VISIT DATE: 09/21/2023

NARRATIVE

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administered as prescribed. R1's responsible party reported they provided R1's medication when R1 moved into the facility. Staff interviewed reported R1's medication was provided on 9/7/23. R1 moved in on 9/4/23. A review of R1's medication shows R1 is still utilizing prescriptions filled from 5/25/23. R1 reported that they have received all their medication as prescribed. Based on the evidence provided the allegation, staff failed to administer medication as prescribed is deemed unsubstantiated. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted and a copy of the report provided.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 4