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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005796
Report Date: 01/05/2022
Date Signed: 01/05/2022 01:58:47 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
12/28/2021 and conducted by Evaluator Michelle Reed
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20211228103358
FACILITY NAME:ACTIVCARE ORANGEFACILITY NUMBER:
306005796
ADMINISTRATOR:LEDESMA, ELVAFACILITY TYPE:
740
ADDRESS:2629 E. CHAPMAN AVENUETELEPHONE:
(858) 565-4424
CITY:ORANGESTATE: CAZIP CODE:
92869
CAPACITY:72CENSUS: 13DATE:
01/05/2022
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Administrator Elva LedesmaTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not allow residents to enter their rooms
Staff interfere with residents sleep
Staff do not assist with incontinence care on a regular basis
Staff do not reposition residents on a regular basis
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst Michelle Reed arrived at the facility to discuss the complaint allegations. Upon arrival, LPA met with Administrator Elva Ledesma. A tour of the facility was conducted. The residents present are located in the " Patriotic and Baseball" wings of the building. There were 2 caregivers and 2 LVNs present. LVNs are present on each shift to assist staff. Interviews were conducted and records were reviewed. LPA observed residents conducting activities. Two residents were asleep in chairs and another was in her room resting. Lunch was to be served so staff did not move the residents into their bedrooms. Naps are usually taken after lunch. Residents who are incontinent are changed every two hours or as needed. Staff interviewed stated that residents may go to their rooms when they want, however, some were fall risks, so they were kept in the living room/activity room for closer observation. Currently there is 1 resident who needs to be repositioned. She is also checked every two hours and sometimes more often. Based upon interviews and a review of records the allegations are unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that staff neglect and violate resident rights. An exit interview was conducted with Administrator Lesdesma and a copy of this report was provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: Michelle ReedTELEPHONE: (714) 743-4958
LICENSING EVALUATOR SIGNATURE:

DATE: 01/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2022
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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