306006242-2-9-2023-22-AS-LMAZ-CNVK98-20230209064151

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306006242
Report Date: 02/08/2023
Date Signed: 02/09/2023 06:41:55 AM

Document Has Been Signed on 02/09/2023 06:41 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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:	306006242
ADMINISTRATOR:	REYNOLDS, TONYA		FACILITY TYPE:	741
ADDRESS:	460 LA FLORESTA DRIVE		TELEPHONE:	(714) 985-5500
CITY:	BREA	STATE: CA	ZIP CODE:	92821
CAPACITY:	200	CENSUS: 155	DATE:	02/08/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Tonya Reynolds		TIME COMPLETED:	03:50 PM

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	Licensing Program Analyst (LPA) Lydia Martinez visited the facility for the purpose of conducting a Pre-Licensing evaluation. The facility has been designed to be a CCRC and as such, will need an RCFE license. Facility is an existing facility and undergoing a Change of Ownership. There are 155 residents in care under current license. An application to operate a Residential Care For the Elderly facility (RCFE-CCRC) was submitted to the Central Applications Unit (CAU) on 09/01/2022 for a total capacity of 200 residents. A Fire Clearance was granted for 173 non-ambulatory and 10 bedridden on 10/04/2022. The facility consists of one main building plus four individual homes on the surrounding grounds. The entire property is an enclosed, gated community. The main structure is a three story residential building with an underground parking garage. This building includes 79 resident units in total. The entire community is designed to accommodate 140 residents. LPA toured the entire community including a sampling of apartment in the main building and one individual home. Hot water in resident apartments is tested and is within regulatory requirements. Fire extinguishers are mounted and charged. Smoke detectors are centrally wired throughout and have been checked by the Fire Department. Residents furnish their own homes, provide there own linens, etc. There is a locked medication room in the "Wellness Center" for those who require medication management. There are a number of locked janitorial closets for storage of toxins and cleaning equipment. An emergency call system is in place in each apartment and home. (cont...LIC809C)

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Lydia Martinez	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023

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

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 306006242
	VISIT DATE: 02/08/2023

NARRATIVE

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There is also a two story building that has been set up to care for residents that have been diagnosed with dementia or memory loss. This is a separate building from the Assisted Living Unit. The total capacity for this unit 55. LPA toured the entire unit during today's visit. Delayed egress systems were in place and working. Strobe lighting is in place for residents who are hard of hearing. Windows in all resident rooms have been set up to have a locking feature to allow residents to open the windows without any risk of elopement. A water fountain in the patio area has been secured with decorative river rock for safety. Heating elements in the kitchen area are adequately secured. Rooms appeared to be properly furnished. The call systems in the rooms were tested.

This facility has submitted a hospice waiver request.

An activity center and gymnasium are available for resident use. There is a very large "koi pond", creek, and water fountain on the premises. LPA noted the area is safe for residents and it seemed adequate. Four large planters were installed in areas surrounding the koi pond.

Component III was completed with Administrator Tonya Reynolds on this date.

The Pre-Licensing is complete and this facility has no deficiencies. All elements verified by LPA appear to be in compliance and the facility is ready to be licensed. The license will be granted upon completion of a final review and approval from the Application Specialist.

An exit interview was conducted and a copy of this report will be emailed.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Lydia Martinez	TELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023

LIC809 (FAS) - (06/04)

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