306000347-9-23-2025-22-AS-SSAS-DLZTMZ-20250930145159

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306000347
Report Date: 09/23/2025
Date Signed: 09/23/2025 11:06:20 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
06/21/2021 and conducted by Evaluator Joseph Alejandre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20210621132714

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 CAPISTANO	STATE: CA	ZIP CODE:	92675
CAPACITY:	140	CENSUS: 105	DATE:	09/23/2025
		UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Christian Woollard		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Resident was malnourished while in care.
Resident is not accorded privacy during visits.
Staff did not safeguard resident's personal items.
Facility is not providing activities for residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to deliver the findings of the complaint investigation into the allegations listed above. LPA met with Community Business Director, Christian Woollard, and explained the reason for the visit.

The investigation into the allegation, facility is not providing activities for residents revealed the following. It was reported that the activities on the activities calendar are not conducted. Resident 1 (R1) resides in memory care. The activities calendar shows activities every day of the week for assisted living and memory care. The memory care director reported that they have music activities where residents can listen to music or they can bowl with plastic pins, and they have card games for the residents. Witness 1 (W1) reported that no activities are conducted, but no other details were provided. LPA observed that during the initial 10-day visit bingo was being conducted and residents were sitting 6 feet apart from each other.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20210621132714

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ATRIA SAN JUAN	FACILITY NUMBER: 306000347
	VISIT DATE: 09/23/2025

NARRATIVE

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In memory care staff were assisting residents with playing individual card games while other residents were listening to music. The Executive Director and the Activities Director reported that activities are always provided but many residents choose not to participate, which makes it very challenging for staff. 3 out of 4 residents interviewed reported that they have participated in activities at the facility. Based on the evidence gathered the allegation, is 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.

The investigation into the allegation, staff did not safeguard resident’s personal items, revealed the following. It was reported that Resident 1 (R1) had their phone taken from them. The Administrator reported that R1’s responsible party refused to have R1’s items inventoried. The Administrator stated that they do not know what items R1 moved in with. Staff 1 (S1) reported that R1’s phone was found outside of their room, so they contacted R1’s responsible party and informed them. S1 reported that they didn’t think R1 could use the phone, so they contacted the responsible party. S1 reported that nothing was done to the phone, and it was given to R1’s responsible party in the condition it was found. R1’s responsible party stated that staff did give the phone back but there were new applications on the phone. R1’s responsible party would not answer any further questions during the investigation. 4 out of 4 staff interviewed reported that when residents’ belongings are found they are turned into lost and found until someone claims them. S1 reported that residents in memory care misplace or lose items, and they give it back to the resident or contact the responsible party. No other items were reported missing. Based on the evidence gathered the allegation 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.

The investigation into the allegation, Resident is not accorded privacy during visits, revealed the following. It was reported that during visits with R1 the family was not given privacy and visits were only allowed in the resident's room 2 times. At the time of the report, visits were allowed at facilities as long as Covid-19 precautions were implemented such as social distancing and wearing masks as outlined in PIN 21-17.1-ASC dated April 23, 2021 and PIN 21-17.2-ASC dated May 14, 2021. The Executive Director reported that all visitors are given privacy and had the choice of visiting in residents’ rooms, in the common areas or outside. 4 out of 4 staff interviewed reported that none of the visitors were denied access to residents' rooms or denied privacy on visits. R1’s responsible party did not answer any questions regarding visitation.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2025

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20210621132714

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ATRIA SAN JUAN	FACILITY NUMBER: 306000347
	VISIT DATE: 09/23/2025

NARRATIVE

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4 our of 4 residents interviewed reported they have always been given privacy during their visits. Based on the evidence gathered the allegation 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.

The investigation into the allegation, resident was malnourished while in care, revealed the following. It was reported that R1 lost 18 pounds during their stay at the facility and was not fed properly. 4 out of 4 staff interviewed reported that Resident 1 (R1) ate and had no issues with food. The Executive Director reported that R1’s responsible party requested meal logs showing R1 was eating and they were provided. A review of the records shows R1 ate breakfast lunch and dinner during their time at the facility from May 1, 2021 to May 18, 2021. On May 19, 2021 R1’s responsible party had R1 sent to Newport Bay Hospital. R1’s physician’s report showed R1 weighed 200 lbs. on April 5, 2021. Newport Bay Hospital closed on February 22, 2023 so no records are available to compare R1’s weight. R1’s where abouts are unknown. No evidence was gathered to support the allegation, therefore the allegation 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.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2025

LIC9099 (FAS) - (06/04)

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