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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005322
Report Date: 10/25/2023
Date Signed: 10/25/2023 10:05:10 AM

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
05/23/2022 and conducted by Evaluator Jerome Haley
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20220523110936
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: 32DATE:
10/25/2023
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Rick Ledesma - Executive Director
Yessenia Noriega - LVN		TIME COMPLETED:
10:15 AM
ALLEGATION(S):
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1) Resident are being restrained while in care.
2) Resident were over-medicated while in care.
3) Residents are not being attended to adequately while in care.
4) Resident are pushed while in care.
5) Resident's diapering needs not being met while care.
6) Resident's are being forced to take medicine while in care.
7) Resident's hygiene needs not being met while in care.
8) Resident's dental needs not being met while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Jerome Haley conducted an unannounced visit for the purpose of delivering the findings on a complaint investigation. LPA Haley met with Rick Ledesma, Executive Director and Yessenia Noriega LVN to explained the purpose of the visit.

During the investigation of the above allegations, LPA interviewed staff, witnesses as well as reviewed and obtained pertinent records. There were no residents identified, room numbers, name of medications or any details provided on the complaint. This facility is an all memory care.

LPA interviewed two facility nurses (S1 and S2), two caregivers(S3 and S4), two residents(R1 and R2) and Rick Ledesma, Executive Director. One out of twenty-six residents stated they have not seen any residents mistreated in any way. The second resident interviewed was unable to answer most of the questions asked.

Continued on LIC9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023
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 3
Control Number 22-AS-20220523110936
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 10/25/2023
NARRATIVE
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All staff members and residents interviewed that they have never witnessed any resident restrained at the facility. LPA toured the facility during a meal and residents were in the dining room eating lunch. Rick Ledesma stated that they have a restraint free policy.

All staff members interviewed stated that they have never witnessed any resident pushed or mistreated by a staff member. Two residents, R1 and R2, interviewed were unable to answer if they have witness a staff push a resident.

Two nurses out of five facility nurses were interviewed and they reported that there are no residents are over-medicated and no residents are forced to take their medications. S1 and S2 stated that they have not seen resident been forced to take medications. Both staff members stated that residents have the right to refuse medications. After three attempts to give the medication and residents continue to refuse and they document it on the E-Mars. Residents who are agitated and may have Ativan as a PRN. The care staff will inform the facility Nurse and the nurse may a PRN medication as prescribed by the resident's physician. All medication handling and Medication Technicians are nurses/LVNs.

Two residents out of twenty six residents reported that staff are friendly, nice and helpful. R1 stated that he has not witnessed any resident mistreated in any way. R1 stated that staff provided good care. R2 was unable to answer if a staff mistreated a resident.

All five staff members interviewed stated each resident has brushed their teeth twice a day. Once in the morning and once in the evening. There are residents whose families would like more than twice and they are brushed three times a day. Staff have daily routines for the morning and evening routine. Residents are showered two to three times a day. There is a facility shower schedule. As for incontinent care, staff stated that all residents who require incontinent care are changed every two hours or as needed. Laundry is done every day for residents. When a resident has laundry, it is completed the same day. S3 stated that all the staff are very good in providing hygiene care to residents. S4 stated that in the morning, residents are dressed, placed in the restroom, their teeth brushed, face washed, hair combed, clothes changed and diaper changed. Residents are showered according to the shower schedule. Then, residents are taken out to the dining room for breakfast afterwards. The caregivers at night have their nightly routine as well.

Continued on LIC9099C
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 22-AS-20220523110936
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 10/25/2023
NARRATIVE
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LPA reviewed shower schedules, janitor services, laundry services, caregiver schedules, medication handling and E-MARs.

There are no residents identified for any of the eight allegations mentioned above. There are no corroborating evidence to support any of these allegations.

Based on the information gathered during the investigation and review of all documents obtained, the following allegations: Resident are being restrained while in care, Resident were over-medicated while in care, Residents are not being attended to adequately while in care, Resident are pushed while in care, Resident's diapering needs not being met while care, Residents are being forced to take medicine while in care, Resident's hygiene needs not being met while in care, Resident's dental needs not being met while in care are deemed Unsubstantiated.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.

An exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3