306006242-1-30-2026-22-AS-APAO-DRGTG2-20260220134224

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006242
Report Date: 01/30/2026
Date Signed: 01/30/2026 04:20:21 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
01/26/2026 and conducted by Evaluator RoseMarie Ruppert

COMPLAINT CONTROL NUMBER: 22-AS-20260126184730

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: 138	DATE:	01/30/2026
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Tonya Reynolds Executive Director		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff does not ensure resident is hydrated.
Staff does not ensure to assist resident with feeding.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to investigate a complaint received in the Regional Office. LPA was greeted and granted entry by the Concierge at 1pm. LPA met with Executive Director (ED) Tonya Reynolds and explained the purpose of the visit.

During the visit, LPA requested the following documents for Resident #1 (R1): Resident Information Sheet, Physician's Report, Individualized Service Plans and Outside Provider Communication sheet from January 26, 2026. LPA also obtained Resident Information Sheets, Physician's Reports for Residents #2, #3 and #4.

It was alleged that Staff does not ensure resident is hydrated. LPA reviewed the Physician's Report from R1 dated February 14, 2025. R1's primary diagnosis is Dehydration and Dementia. LPA reviewed Individualized Service Plans from February 14, 2025 and on December 11, 2025. Due to a change of condition, the re-assessment from December 11, 2025 stated R1 required assistance with eating. LPA reviewed Charting
(Continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2026

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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Control Number 22-AS-20260126184730

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: 01/30/2026

NARRATIVE

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(Continued from LIC 9099)

Notes January 4 - January 29. 2026. Charting Notes report R1 is being fed and hydrated on January 4th and a change of condition occurred on January 14, 2026. Home Health was contacted regarding R1 having issues with swallowing. On January 16, 2026 the nurse assessed R1's swallowing and noted R1 was able to swallow water, as well as Ensure; a thicker liquid. The Responsible Party was notified by the nurse and continued to be updated of R1's changing condition. R1 was noted to be lethargic on January 20. 2026. Charting continued to document R1's food intake and hydration On January 25, 2026 R1 was lethargic and refused fluids or food. R1 was sent out to the hospital for further evaluation at 3;30pm. On January 26, 2026 home health recommended an R1 assessment for hospice but R1 was in the hospital at this time.

It was also alleged that Staff does not ensure to assist resident with feeding. LPA interviewed four of four staff members who all denied this allegation. Staff stated R1 was full assistance and was assisted with each meal in the dining room unless R1 refused. LPA interviewed three of three residents. Three of three residents denied the allegation that they are not assisted with getting food or water. LPA interviewed one witness who stated staff did not ensure resident was being fed or given proper hydration.

Based on LPA's record review, observations and interviews the allegations that Staff does not ensure resident is hydrated and Staff does not ensure to assist resident with feeding are Unsubstantiated. The allegations may have happened or are valid, but there is not a preponderance of evidence to prove that the alleged violations occurred.

An exit interview was conducted with Tony Reynolds, Executive Director and a copy of this report and LIC 811 were provided to the facility.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2026

LIC9099 (FAS) - (06/04)

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