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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004555
Report Date: 11/05/2021
Date Signed: 12/14/2021 10:55:32 AM



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
11/03/2021 and conducted by Evaluator Jennifer Walden
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20211103104617
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: DATE:
11/05/2021
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:TC w/ Tonya ReynoldsTIME COMPLETED:
10:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Provider failed to conduct and post the biennial survey required by HSC 1771.7(d)(2)
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Associate Governmental Program Analyst (AGPA) Jennifer Walden conducted a telephone interview on November 5, 2021 at approx. 1115a with Executive Director Tonya Reynolds. Allegation reviewed and the complainant was interviewed.

Based on AGPAs interview and records review of the 2019 and 2020 resident survey and notice of survey to residents and 2021 survey notice to residents and separately the distribution of the survey and confirmation from the ED that the results are posted in the Activity room, we have found the allegation to be UNFOUNDED, meaning that the allegation is false, did not happen, or is without a reasonable basis.

No deficiencies are noted at this time. Copy of report provided to the facility.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Allison NakatomiTELEPHONE: (916) 531-5336
LICENSING EVALUATOR NAME: Jennifer WaldenTELEPHONE: (916) 651-8148
LICENSING EVALUATOR SIGNATURE:

DATE: 12/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2021
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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