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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006242
Report Date: 12/17/2025
Date Signed: 12/17/2025 03:26:51 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
12/01/2025 and conducted by Evaluator RoseMarie Ruppert
COMPLAINT CONTROL NUMBER: 22-AS-20251201144751
FACILITY NAME:CAPRIANAFACILITY NUMBER:
306006242
ADMINISTRATOR:REYNOLDS, TONYAFACILITY TYPE:
741
ADDRESS:460 LA FLORESTA DRIVETELEPHONE:
(714) 985-5500
CITY:BREASTATE: CAZIP CODE:
92821
CAPACITY:200CENSUS: 142DATE:
12/17/2025
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Tonya Reynolds, Executive DirectorTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff neglected resident and left them in the room.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to deliver findings for a complaint received in the Regional Office. LPA was greeted and granted entry by the Concierge. LPA met with Executive Director (ED) Tonya Reynolds and explained the purpose of the visit.

It was alleged that staff neglected resident and left them in the room. On November 25, 2025, Resident #1 (R1), who resides in Villagio in the Memory Care, was left in the bedroom with an industrial fan and strong odors from the cleaning product used for carpets. R1 was observed to be cold and there were no windows opened in the room.

On December 4, 2025, LPA reviewed Resident #1 (R1): Identification and Emergency Information, Physician's Report, and Needs and Services Plan. R1 has a diagnosis of dementia. LPA interviewed R1 who understood the carpet was cleaned but did not know who requested for the carpet to be cleaned. LPA
(Continued on LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2025
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-20251201144751
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: CAPRIANA
FACILITY NUMBER: 306006242
VISIT DATE: 12/17/2025
NARRATIVE
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(Continued from LIC 9099)

also interviewed R1's spouse, Resident #2 (R2) who was not present when the carpet cleaning occurred. R2 visits R1 every afternoon and did not smell odors during the afternoon visit on November 25, 2025. R2 also was not sure why the carpet was cleaned. Two of two residents could not confirm the allegation when questioned. LPA obtained the TELS work order; which can be entered for any cleaning or repair work by facility staff, residents or families. A work order was placed on November 20, 2025 to clean the carpet in R1's room.

LPA interviewed three of three witnesses. One of three witnesses, Witness #2 (W2), observed R1 shivering in the room upon entry and confirmed the allegation. Two of the three witnesses were not present and could not confirm, nor deny the allegation that Staff neglected resident and left them in the room.

LPA interviewed three of three staff members regarding the allegation Two of three staff members stated they asked Resident #1 (R1) if they wanted to exit the room while the carpet was cleaned but R1 did not respond. Staff offered assistance to R1 several times, in different ways, if R1 would like to leave the room but R1 did not want to move. Staff stated they were in and out of the room within thirty minutes. Three of three staff members denied the allegation that Staff neglected resident and left them in the room.

LPA reviewed the Material Safety Data Sheet (MSDS) for the carpet cleaner. The cleaner is approved for facility use and according to the staff member who cleaned the carpet, is used frequently to clean carpets throughout the facility. After cleaning R1's carpet on November 25, 2025, staff left the apartment door open and used the industrial fan to quickly dry the carpet area. A second staff member checked on R1 and provided a blanket for the resident; when it was brought to the staff member's attention that R1 appeared cold. The staff member also quickly removed the industrial fan from the area.

Based on LPA's record review, observations and interviews, the allegation that Staff neglected resident and left them in the room is Unsubstantiated. The allegation may have happened or is valid, but there is not a preponderance of evidence to prove that the alleged violation occurred. An exit interview was conducted with Executive Director, Tonya Reynolds, and a copy of this report was provided to the facility.



SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2