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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005322
Report Date: 07/26/2022
Date Signed: 07/26/2022 12:39:17 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 07/26/2022 12:39 PM - 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:ACTIVCARE AT YORBA LINDAFACILITY NUMBER:
306005322
ADMINISTRATOR:ELVA LEDESMAFACILITY TYPE:
740
ADDRESS:4725 VALLEY VIEW AVETELEPHONE:
(714) 577-8005
CITY:YORBA LINDASTATE: CAZIP CODE:
92886
CAPACITY:60CENSUS: 24DATE:
07/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Executive Director Rick LedesmaTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Michelle Reed arrived at the facility to conduct a Required 1 Year inspection. The inspection focused primarily on Infection Control. LPA was greeted by Executive Director Rick Ledesma. Mr. Ledesma stated that there are no known Covid positives at the facility. LPA's temperature was taken upon entry and a Computer Tablet was available for signing in and checking for Covid symptoms. Hand sanitizer was available. Staff were observed wearing masks upon entry and throughout the visit. The facility is licensed for 60 non-ambulatory residents of which may be bedridden. The facility also has a Hospice waiver for 15 residents. Currently there are 24 residents of which are receiving Hospice services.

At approximately 11:15 AM LPA Reed conducted a tour of the physical plant along with Executive Director Rick Ledesma. Residents' and staff were observed outside enjoying the sunshine and others sitting inside or in their rooms resting. Resident bedrooms had the required furnishings, bed linens, and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, showers were free of mold/mildew and a non-skid surface or mat was in place. Soap, paper towels and toilet paper were present. Resident bath towels and personal hygiene supplies were adequately stocked. LPA tested the hot water temperature in and the temperature measured at 107 degrees F.

Perishable and non-perishable food supply was adequately stocked at the time of the visit. The fire extinguishers were fully charged. The smoke and carbon monoxide detectors are

SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: Michelle ReedTELEPHONE: (714) 743-4958
LICENSING EVALUATOR SIGNATURE:
DATE: 07/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/26/2022
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: ACTIVCARE AT YORBA LINDA
FACILITY NUMBER: 306005322
VISIT DATE: 07/26/2022
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inspected yearly by First Choice Fire Protection. The last inspection was in September of 2021. Medications, toxins and sharps in the areas inspected were locked and inaccessible to residents/clients.

The outdoor patios had shading and sufficient seating for residents. Walkways were clear of hazards and the facility is approved for delayed egress and locked perimeters.

No resident or staff files were reviewed at the time of this visit. LPA noted Covid precaution signs posted outside and inside the facility as well as a 30 day supply of PPE. Licensee has also submitted their Infection Control Plan and it was also available for review.

LPA discussed Assembly Bill 665. This bill requires residential facilities serving adults, residential care facilities for persons with chronic life-threatening illness, and residential care facilities for the elderly with existing internet service to provide at least one internet access device that can support real-time interactive applications, is equipped with video conferencing technology, and is dedicated for client or resident use.

There were no deficiencies issued during this 1 Year inspection. An exit interview was conducted with Rick Ledesma and a copy of this report was provided at the time of this visit.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: Michelle ReedTELEPHONE: (714) 743-4958
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2022
LIC809 (FAS) - (06/04)
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