<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004555
Report Date: 11/05/2020
Date Signed: 11/05/2020 05:02:41 PM



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
05/06/2020 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20200506084825
FACILITY NAME:CAPRIANAFACILITY NUMBER:
306004555
ADMINISTRATOR:TONYA REYNOLDSFACILITY TYPE:
741
ADDRESS:460 LA FLORESTA DRTELEPHONE:
(714) 589-2866
CITY:BREASTATE: CAZIP CODE:
92821
CAPACITY:200CENSUS: 140DATE:
11/05/2020
UNANNOUNCEDTIME BEGAN:
04:15 PM
MET WITH:Tonya ReynoldsTIME COMPLETED:
04:34 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility did not protect resident from financial abuse.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Joseph Alejandre contacted the facility via telephone to conclude a complaint investigation via telephone due to COVID-19 and precautionary measures. LPA identified himself and discussed the purpose of the call and the elements of the allegation with Executive Director Tonya Reynolds. During the investigation, LPA interviewed staff, residents, and witnesses as well as reviewed and obtained pertinent documentation. Regarding the allegation “facility did not protect resident from financial abuse”: It was alleged that Capriana Staff #1 (S1) befriended Resident #1 (R1) and took R1 shopping and banking where S1 would utilize R1’s ATM card to take money from R1’s account for S1’s own personal gain. Through the course of the investigation, LPA was provided with records of R1’s banking statements which indicated unauthorized purchases made at various establishments as well as unauthorized checks written out to S1 during the period of January 2020 through April 2020. S1 and R1 were observed to have exited the facility through a side door and S1 transported R1 to banking establishments and grocery stores utilizing S1’s personal vehicle. S1 was never associated to the facility as a staff member. Continued on LIC9099C.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2020
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 3
Control Number 22-AS-20200506084825
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: CAPRIANA
FACILITY NUMBER: 306004555
VISIT DATE: 11/05/2020
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
 A concurrent investigation by Brea Police Department (BPD) is being conducted for unauthorized purchases and withdrawals from R1’s bank account. Based on LPA interviews which were conducted, as well as record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. The following violation is being cited per California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted with Administrator via telephone and a copy of this report along with attached citation and Licensee/Appeal Rights (LIC 9058 01/16) was provided to Administrator via email and an electronic email read receipt confirms receiving these documents.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20200506084825
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: CAPRIANA
FACILITY NUMBER: 306004555
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/05/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/06/2020
Section Cited
HSC
1569.269(a)(10)
1
2
3
4
5
6
7
Enumerated rights; severability (a)
Residents of residential care facilities for the elderly shall have all of the following rights: (10) To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse. This requirement
1
2
3
4
5
6
7
Licensee states all staff will be trained on resident rights HSC 1569.269 Enumerated rights; severability. Licensee to forward proof of training to LPA by POC date.
8
9
10
11
12
13
14
is not being met as evidenced by; The Licensee did not ensure R1 was free from financial abuse while under the facility’s care. Based on interviews and record review, S1 fraudulently utilized R1’s funds for personal use. This poses a potential health, safety and personal rights risk to residents in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2020
LIC9099 (FAS) - (06/04)
Page: 3 of 3