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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005796
Report Date: 08/08/2022
Date Signed: 08/08/2022 02:58:13 PM


Document Has Been Signed on 08/08/2022 02:58 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 ORANGEFACILITY NUMBER:
306005796
ADMINISTRATOR:LEDESMA, ELVAFACILITY TYPE:
740
ADDRESS:2629 E. CHAPMAN AVENUETELEPHONE:
(714) 215-9944
CITY:ORANGESTATE: CAZIP CODE:
92869
CAPACITY:72CENSUS: 15DATE:
08/08/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Elva LedesmaTIME COMPLETED:
03:00 PM
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Licensing Program Analyst Michelle Reed arrived at the facility to conduct a case management visit. Upon arrival, LPA met with Administrator Elva Ledesma. The visit was conducted to check on the disposal of PPE at the facility. A tour of the physical plant was conducted inside and outside with Ms. Ledesma. During the tour LPA noted that trash as well as gloves and masks were stored in covered containers. LPA did not notice any trash in or around the parking lot.

The facility is right behind OC Medical Center and shares an adjacent parking lot. OC Medical Center has a trash receptacle in their parking. The trash dumpster and staff parking lot for Activcare are in the back of the building. LPA noted that the dumpster was covered and trash bags were tied shut. There is also a covered trash can outside the exit to the parking lot where staff can dispose of their trash as needed. Elva Ledesma also stated that their Maintenance Director does conduct a routine check of the grounds looking for trash.

No citations issued at the time of this visit.

An exit interview was conducted and a copy of this report was provided to Ms. Ledesma.


SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: Michelle ReedTELEPHONE: (714) 743-4958
LICENSING EVALUATOR SIGNATURE:
DATE: 08/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/08/2022
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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