306005986-10-25-2024-22-AS-LMOA-DAG7V3-20241027215917

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005986
Report Date: 10/25/2024
Date Signed: 10/25/2024 09:02:59 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
09/17/2024 and conducted by Evaluator Claudia Gutierrez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20240917082750

FACILITY NAME:	ACTIVCARE LAGUNA HILLS		FACILITY NUMBER:	306005986
ADMINISTRATOR:	MILLER, PATRICIA		FACILITY TYPE:	740
ADDRESS:	25200 PASEO DE ALICIA		TELEPHONE:	(858) 565-4424
CITY:	LAGUNA HILLS	STATE: CA	ZIP CODE:	92653
CAPACITY:	72	CENSUS: 51	DATE:	10/25/2024
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Alejandra "Alex" Montenegro		TIME COMPLETED:	09:15 AM

ALLEGATION(S):

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Staff does not keep facility free from pests.

INVESTIGATION FINDINGS:

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An unannounced Complaint Investigation was conducted on this day by Licensing Program Analysts (LPAs) Claudia Gutierrez and Nancy Guillen regarding the allegation mentioned above. LPAs met with Licensed Vocational Nurse (LVN) Alex Montenegro and explained the purpose of the inspection.

During the course of the investigation, LPA Gutierrez conducted a tour of the facility, interviewed residents and staff, obtained and reviewed facility Building Maintenance Work Order Request Forms and Pest Control Service Reports, and the following was revealed:

On August 13, 2024, Building Maintenance Work Order Request Form was submitted reporting ants in the medication room and in a vacant bedroom. Per Service Report from Pest Control Company dated August 13, 2024, "For today’s service, I treated around both exterior courtyards around all walkways, windows, as well as around base of buildings. I then treated the rest of the exterior of the building as well as inspected and refilled all rodent monitoring stations as needed. (Cont. LIC9099-C)

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2024

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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Control Number 22-AS-20240917082750

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 LAGUNA HILLS	FACILITY NUMBER: 306005986
	VISIT DATE: 10/25/2024

NARRATIVE

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Minimal rodent activity noted during this service.” Service report also stated, “Please allow 3 to 5 days to take full effect.”

On August 14, 2024, Building Maintenance Work Order Request Form was submitted stating "ants in nurse room!" Per same Work Order, on the same date, the area was treated and signed off by Staff 1 (S1). On August 21, 2024, Building Maintenance Work Order Request Form was submitted reporting ants in two resident bedrooms. Per same Work Order, on the same date, the area was treated and signed off by S1. On August 23, 2024, Building Maintenance Work Order Request Form was submitted reporting ants in a resident bedroom. Per same Work Order, on the same date, area was treated and signed off by S1. On August 29, 2024, Building Maintenance Work Order Request Form was submitted reporting ants in another resident bedroom. Per same Work Order, on the same date, area was treated and signed off by S1. On September 03, 2024, Building Maintenance Work Order Request Form submitted reporting ants in a fourth resident’s bedroom. Per same Work Order, on the same date, the area was treated and signed off by S1.

On September 3, 2024, at 11:19 a.m., S1 attempted to schedule soonest appointment with a Pest Control Company via text message and an appointment was scheduled for September 12, 2024. Per Service Report from Pest Control Company dated September 12, 2024, "For today’s service, I treated around both exterior courtyards around all walkways, windows, as well as around base of buildings. I then treated the rest of the exterior of the building as well as inspected and refilled all rodent monitoring stations as needed. Minimal rodent activity noted during this service. Extra heavy treatment on exterior per customer request due to concerns about increasing pest sightings.” Service report also stated, “Please allow 3 to 5 days to take full effect.”

On September 23, 2024, at 2:15 p.m. S1 reached out to Pest Control Company Representative via text message asking when they would be able to return to provide additional services and received no response. On September 24, 2024, at 8:47 a.m., S1 again reached out to Pest Control Representative via text message stating: "Please respond every morning I'm getting reports of ants...” Text message received from Pest Control Representative stated “I can be there around 2pm. I will call you when I get there."

(Cont. LIC9099-C)

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2024

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20240917082750

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 LAGUNA HILLS	FACILITY NUMBER: 306005986
	VISIT DATE: 10/25/2024

NARRATIVE

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Per Service Report dated September 24, 2024, "Completed re-treatment for ants… I made sure to treat the base of the buildings as well as underneath all windows. I also inspected for all ant activity. No trails of ants found along exterior.”

On September 25, 2024, during initial complaint investigation, LPA conducted a tour of the facility and observed select resident rooms alleged to have ants. LPA did not observe the presence of any ants or other pests in resident bedrooms, common areas, or exterior of the facility.

Interviews were conducted with three staff, and five residents regarding the allegation. Three of three staff interviewed stated ants had been present in the facility, in common areas and resident rooms over the summer, however, stated that upon identifying the presence of ants, staff are to submit a maintenance ticket and it is addressed within 24 hours by maintenance staff.

During their interview, maintenance staff, S1, stated that a Pest Control Company is contracted at least monthly and sprays treatment in a perimeter around the facility. Per S1, it was discovered there was a tree branch touching the roof of the facility and ants were avoiding the perimeter by climbing up the tree, onto the branch touching the roof, and obtaining access inside the facility that way. Per S1, once this was discovered, the area was treated immediately. S1 stated that since the tree branch discovery, the tree was trimmed, and the branch is no longer touching the roof of the facility.

Two of five residents interviewed denied the presence of pest including ants in the facility or their bedroom. Three of five residents interviewed were unable to confirm or deny the presence of ants.

Based on observations and information received during interviews conducted, LPA is unable to determine if staff are not keeping facility free from pests. Although the above allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore at this time the above allegation is unsubstantiated.

An exit interview was conducted and copy of this report was provided at the end of the inspection.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2024

LIC9099 (FAS) - (06/04)

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