306000347-12-4-2023-22-AS-SSAS-CYBNB8-20231208091842

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306000347
Report Date: 12/04/2023
Date Signed: 12/04/2023 11:08:54 AM

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
11/29/2023 and conducted by Evaluator Joseph Alejandre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20231129103032

FACILITY NAME:	ATRIA SAN JUAN		FACILITY NUMBER:	306000347
ADMINISTRATOR:	SABRINA PRIESMAN		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: 72	DATE:	12/04/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Sabrina Priesman		TIME COMPLETED:	11:20 AM

ALLEGATION(S):

1
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9

Facility failed to provide resident's records to authorized representative.

INVESTIGATION FINDINGS:

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11
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13

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 (ED) Sabrina Priesman and explained the reason for the visit. LPA and ED Priesman toured the facility. The investigation into the allegation, facility failed to provide resident's records to authorized representative revealed the following. The ED reported that Resident 1 (R1) has never lived at the facility. A review of facility records shows R1 was never a resident at the facility. The ED reported that no request was received regarding the request of records for R1. Based on the evidence gathered the allegation, facility failed to provide resident's records to authorized representative is deemed 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.

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: 12/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2023

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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