<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306005322
Report Date:
07/19/2021
Date Signed:
07/19/2021 01:35:33 PM
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 LINDA
FACILITY NUMBER:
306005322
ADMINISTRATOR:
ELVA LEDESMA
FACILITY TYPE:
740
ADDRESS:
4725 VALLEY VIEW AVE
TELEPHONE:
(714) 577-8005
CITY:
YORBA LINDA
STATE:
CA
ZIP CODE:
92886
CAPACITY:
60
CENSUS:
26
DATE:
07/19/2021
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
12:12 PM
MET WITH:
Rick Ledesman, Executive Director
TIME COMPLETED:
01:41 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) Jim August conducted an unannounced visit for the purpose of conducting a required annual visit. LPA was greeted and granted entry into the facility by Executive Director Rick Ledesman and explained the reason for the visit.
LPA August toured the facility. There are twenty-six residents residing in the facility and no active covid-19 cases. LPA observed some residents on site. All residents appeared clean and well taken care of. Residents were social distancing. LPA observed required department postings in the facility as well as hand washing signs throughout the facility. All restrooms observed had ample soap/ sanitizer and appeared clean. Facility is taking residents temperatures daily and documenting results. LPA observed the emergency disaster and evacuation plans. Facility has back-up emergency food and water supply as well as PPE supplies. Facility has completed the LIC808 Mitigation Plan and LPA August approved the plan on site. Facility is still performing Covid surveillance testing as required by the latest guidance.
No citations noted during today's visit. Exit interview conducted and a copy of this report was left at the facility.
SUPERVISOR'S NAME:
Sheila Santos
TELEPHONE:
(714) 703-2857
LICENSING EVALUATOR NAME:
James August
TELEPHONE:
714-703-2853
LICENSING EVALUATOR SIGNATURE:
DATE:
07/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/19/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
Page:
1
of
1