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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005949
Report Date: 12/11/2025
Date Signed: 12/11/2025 03:10:41 PM

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
11/06/2024 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20241106125531
FACILITY NAME:CAPISTRANO SENIOR LIVINGFACILITY NUMBER:
306005949
ADMINISTRATOR:BRYAN HADLEYFACILITY TYPE:
741
ADDRESS:31741 RANCHO VIEJO ROADTELEPHONE:
(844) 375-0029
CITY:SAN JUAN CAPISTRANOSTATE: CAZIP CODE:
92675
CAPACITY:125CENSUS: 103DATE:
12/11/2025
UNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Anabella RealTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Facility mismanaged resident's medication
Facility did not ensure that resident received medical care
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 the Wellness Director Anabella Real and explained the reason for the visit. The investigation into the allegation, facility mismanaged resident's medication, revealed the following. It was reported that Resident 1(R1) did not receive Eliquis and Lasix for three days. A review of records show R1 moved into the facility on October 25, 2024 for respite care. R1's medication was handled by the facility. Staff reported that R1 provided medication from their last hospital visit at the time of move in. The Wellness Director reported that when R1 moved in, R1 did not have a doctor so they recommended a doctor for R1. R1 did not choose a doctor until October 31, 2024. R1 was self responsible and their physician report dated October 18, 2024 shows R1 can leave the facility unassisted. Staff reported that R1 provided medication at the time of move in on October 25, 2024 including Eliquis and Lasix. Staff reported that R1 did run out of Eliquis and Lasix but it could not be refilled until R1 choose a doctor. The Wellness Director reported that R1 choose a doctor on October 31, 2024.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
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 2
Control Number 22-AS-20241106125531
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: CAPISTRANO SENIOR LIVING
FACILITY NUMBER: 306005949
VISIT DATE: 12/11/2025
NARRATIVE
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R1 and their emergency contact never responded to requests for an interview. The Wellness Director reported that R1 did not agree to having a doctor until after their medication ran out. Facility staff reported that R1 had no reported issues from October 25, 2024 to November 4, 2024. Staff reported that until R1 picked a physician there was nothing they could do about having R1's prescriptions filled. Facility records show R1 had a doctor visit on October 31 and their doctor prescribed medications that day. The Wellness Director reported that R1 was advised to choose a doctor as soon as possible so any required care wouldn't be delayed. Staff reported that once prescribed all medications were issued as prescribed. A review of medication records show R1 was prescribed 23 medications after their appointment. None of the evidence gathered supports the allegation, therefore the allegation, facility mismanaged resident's medication, 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, facility did not ensure that resident received medical care, revealed the following. It was reported that when R1 moved in they were told they would have home health visits and no home health visits were provided until a week after R1 moved into the facility. The Wellness Director reported that at the time of move in R1 had no doctor and once they had a doctor (R1 choose a doctor on October 31, 2024) a home health visit was scheduled for November 3, 2024. Facility records show R1 had a home health visit on November 3, 2024. The Wellness Director reported that R1 was advised to choose a doctor as soon as possible so any required care wouldn't be delayed. It was reported that on November 5, 2024, R1 repeatedly called for assistance and staff did not answer for 90 minutes. R1 and their emergency contact never responded to requests for an interview. Staff 1 reported that around 4:00 am, R1 requested assistance using the call system. Staff 1 reported they responded and saw R1 was having issues breathing. Staff 1 reported that they were going to call 911 but R1 reported they had already called 911. The facility call system only keeps records for one week and the records were no longer available at the time of the initial 10-day visit to begin the investigation. R1 was transported to the hospital. The Administrator reported that after R1 went to the hospital on November 5, 2024 they never returned to the facility. The Administrator reported that R1 did not return any calls to the facility. Based on the evidence gathered the allegation, facility did not ensure that resident received medical care, 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: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2