306005322-6-17-2026-22-AS-LMOA-DWJ6JQ-20260731205130

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005322
Report Date: 06/17/2026
Date Signed: 06/17/2026 04:39:40 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
04/14/2026 and conducted by Evaluator Edward Kim

COMPLAINT CONTROL NUMBER: 22-AS-20260414132445

FACILITY NAME:	ACTIVCARE AT YORBA LINDA		FACILITY NUMBER:	306005322
ADMINISTRATOR:	ENRIQUE LEDESMA		FACILITY TYPE:	740
ADDRESS:	4725 VALLEY VIEW AVE		TELEPHONE:	(714) 577-8005
CITY:	YORBA LINDA	STATE: CA	ZIP CODE:	92886
CAPACITY:	80	CENSUS: 53	DATE:	06/17/2026
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Marketing Director- Shannen Buckholz		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff are not using a proper place to wash residents clothing
Staff are not meeting residents diapering needs
Staff are contaminating surfaces in residents rooms
Staff did not ensure the facility was not malodorous
Staff are not showering residents when needed
Staff are not ensuring the facility floors are clean

INVESTIGATION FINDINGS:

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On June 17, 2026, 8:00 AM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced subsequent complaint visit to deliver findings at the above facility for the above allegations. LPA Kim met with Marketing Director Shannon Buckholz and explained the purpose of the visit. Administrator Enrique Ledesma was out of the office for the week, and the Facility Designee of Responsibility is Marketing Director Buckholz.
The investigation consisted of the following: LPA Kim conducted a physical tour of the facility. LPA Kim reviewed and obtained copies of staff roster, resident roster, staff schedule, staff information, facility cleaning schedule, and seven resident’s record, which include: Admission Agreement, Identification and Emergency Information, Physician's Report, Needs and Services Plans/Reappraisal, Progress notes, and other pertinent records. LPA Kim reviewed and obtained copies of two staff files, which include: contact information, employee application, and LIC 503.
The investigation revealed the following:
Continued on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2026

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 5

Control Number 22-AS-20260414132445

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: ACTIVCARE AT YORBA LINDA	FACILITY NUMBER: 306005322
	VISIT DATE: 06/17/2026

NARRATIVE

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Allegation: Staff are not using a proper place to wash residents clothing
It is alleged that In the dining area, soiled garments and briefs were washed together in a container and left to air dry on counters.

Based on interviews conducted, five residents and five staff denied the allegation. Five residents and four staff stated that they have not witnessed any clothes, soiled or unsoiled, left to air dry on counters. The residents and staff stated there was not an instance where they watched anyone wash soiled garments and briefs in any container or in the sink at the common areas. S3 and S4 stated there are facility barrels in each hallway for residents and staff to drop off soiled clothes and garments. The Janitor picks it up twice a day. Laundry aids are the only people to wash and clean clothes and garments. They only place to clean in the facility is the designated laundry area. They do not wash or dry clothes outside the designated laundry room and drying areas.

Based on observation, on April 22, 2026, and June 17, 2026, LPA observed there was no clothes being washed in a container in common areas. LPA did not observe any clothes that were left to air dry on counters, tables, and chairs in the common area. LPA went to the designated laundry room and drying areas to observe and confirm S3 statement that laundry aids only washed and dried clothes in these designated areas.
Based on information gathered, there is no sufficient evidence to corroborate the above allegation.

Allegation: Staff are not meeting residents diapering needs
It is alleged that in a resident’s room, a caregiver did not wash resident completely and there was some fecal matter left on the resident’s hip, despite being told there was a dirty spot.

Based on record review, LPA reviewed the Bowel Movement record for April 2026 and June 2026. The facility keeps track of bowel movement and when they provide diapering changes for the residents. There is no record for if showers were provided when a bowel movement occurred. Based on interviews, five residents and five staff denied the allegation. All staff and residents stated the staff thoroughly clean the residents. S1 and S3 stated that if the resident requested a shower after changing their diapers, then they would provide a shower if requested Based on observation, on April 22, 2026, and June 17, 2026, LPA did not observe any caregivers not properly providing residents for their diapering needs.
Based on information gathered, there is no sufficient evidence to corroborate the above allegation.
Continued on LIC9099C

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 22-AS-20260414132445

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: ACTIVCARE AT YORBA LINDA	FACILITY NUMBER: 306005322
	VISIT DATE: 06/17/2026

NARRATIVE

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Allegation: Staff are contaminating surfaces in residents rooms
It is alleged caregivers are placing soiled briefs containing feces on bedside surfaces, including near pillows and bed areas.

Based on interviews, five residents and fivestaff denied the allegation. All staff and residents stated that there have been no instances where soiled clothes or briefs were placed on a resident’s bed, pillows, or other surface areas in a resident’s room. S1 and S2 stated whenever a resident gets their briefs changed, they place the soiled briefs in a trash bin, and place the soiled clothes in another bag. The soiled clothes will go to facility barrels to be picked up to be washed in the laundry, and the soiled briefs will be taken out of the room and disposed properly. Based on observation, on April 22, 2026, and June 17, 2026, LPA did not observe any soiled clothes or soiled briefs with feces placed on any resident’s bed, pillows, or any surfaces in the resident’s room

Based on information gathered, there is no sufficient evidence to corroborate the above allegation.

Allegation: Staff did not ensure the facility was not malodorous
It is alleged that throughout the facility, including hallways, there is a strong persistent odor of urine.

Based on record review, Housekeeping Assignment indicates the following common areas must be cleaned everyday: offices, bathrooms, copy room, conference room, medication room, shower rooms, all hallways, 300 Hall public restroom, beauty room, and they need to dust the kitchenettes. The following rooms need to be cleaned everyday: 105, 107, 204, 206, 209, 301, 304, 305, 307, 405, 408, and 409. Based on observations, on April 22, 2026, and June 17, 2026, LPA did not smell a strong persistent odor of urine or any other malodorous odor anywhere in the facility.

Based on interviews, five residents and five staff denied the allegation. Residents and staff stated they have not had smelled a strong persistent odor of urine or any other malodorous odor. S5 stated they regularly clean the facility to make sure the hallways and public areas are clean and sanitary. S5 stated they will follow all steps to make sure there is no odor of urine or any malodorous odor in the facility.

Based on information gathered, there is no sufficient evidence to corroborate the above allegation.

Continued on LIC9099C

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 22-AS-20260414132445

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: ACTIVCARE AT YORBA LINDA	FACILITY NUMBER: 306005322
	VISIT DATE: 06/17/2026

NARRATIVE

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Allegation: Staff are not showering residents when needed
It is alleged that a resident had significant diarrhea and was not properly cleaned or showered. The caregiver stated that residents are typically wiped and not immediately showered. It was alleged the resident was only cleaned partially.

Based on record review, a shower schedule for 100 Hall, 200 Hall, 300 Hall, and 400 hall list all the residents who need assistance for showers during the week. Facility do not keep a record when a resident requests additional showers outside of their shower schedule. Based on interviews, five residents and five staff denied the allegation. S3 stated the facility follows the shower schedule. S4 confirmed that the facility does not keep a record of when residents request additional showers after a bowel movement or diapering change. All staff stated if a resident requested a shower after bowel movement, or if the staff believed it was necessary, a shower would be provided. Five residents stated the facility maintains and cleans them regularly thoroughly.

Based on information gathered, there is no sufficient evidence to corroborate the above allegation.

Allegation: Staff are not ensuring the facility floors are clean
It is alleged that urine was left on the floor in a hallway area and not cleaned up.

Based on interviews, five staff and five residents denied the allegation. S2 stated they do not keep a log when they clean up urine or other substances in the hallway. All staff and all residents stated the facility maintains a clean facility where it is rare to see urine and other substances in the facility. S4 and S5 stated that it is common to see spills and substances in the dining areas. All staff stated that if there were spills or urine left, they would contact housekeeping and maintenance. S5 stated they would make sure everything is cleaned up properly and is sanitary. Based on observations, on April 22, 2026, and June 17, 2026, LPA did not observe any urine or any spills on the floor in any hallways. LPA observed spills from the dining areas, but the facility promptly cleaned up all the messes in a timely manner and kept the area sanitary.

Based on information gathered, there is not sufficient evidence to corroborate the above allegation

Based on records review, interviews, and observations, LPA did not find sufficient evidence to support the above allegations Staff are not using a proper place to wash residents clothing, Staff are not meeting
Continued on LIC9099C

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2026

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 22-AS-20260414132445

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: ACTIVCARE AT YORBA LINDA	FACILITY NUMBER: 306005322
	VISIT DATE: 06/17/2026

NARRATIVE

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residents diapering needs, Staff are contaminating surfaces in residents rooms, Staff did not ensure the facility was not malodorous, Staff are not showering residents when needed, and Staff are not ensuring the facility floors are clean. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview was conducted a copy of the report was provided to Marketing Director Shannen Buckholz.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2026

LIC9099 (FAS) - (06/04)

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