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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005986
Report Date: 04/17/2025
Date Signed: 04/17/2025 04:00:48 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
04/14/2025 and conducted by Evaluator Ruth Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250414095416
FACILITY NAME:ACTIVCARE LAGUNA HILLSFACILITY NUMBER:
306005986
ADMINISTRATOR:MILLER, PATRICIAFACILITY TYPE:
740
ADDRESS:25200 PASEO DE ALICIATELEPHONE:
(858) 565-4424
CITY:LAGUNA HILLSSTATE: CAZIP CODE:
92653
CAPACITY:72CENSUS: 51DATE:
04/17/2025
UNANNOUNCEDTIME BEGAN:
01:43 PM
MET WITH:Patricia MillerTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff did not meet a resident's dental needs while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit to the facility to investigation the above identified complaint allegation. LPA arrived at facility and was greeted at the door and granted entry receptionist. LPA spoke with Patricia Miller, Executive Director and explained the purpose of the visit.

During the course of the investigation, interviews were conducted, a tour of the physical plant of the facility was conducted, a review of resident records was completed and copy of pertinent documents obtained.

It is alleged that staff did not meet a resident’s dental needs while in care. Interview with 3 of 3 staff stated that R1 can become combative at times and physical. R1 can be cooperative upon initial services care

Continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2025
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 2
Control Number 22-AS-20250414095416
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 LAGUNA HILLS
FACILITY NUMBER: 306005986
VISIT DATE: 04/17/2025
NARRATIVE
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and then can become combative/agitated with staff. Staff (S3) states they provide care for R1 and has prepared the supplies for brushing teeth and provided cueing. This month R1’s care for dental was changed to full assistance with oral care. Review of resident (R1) records the services plan from October 2024, and March 2025, revealed that dental needs/details: set up, verbal cueing with minimum assist. Services plan from April 2025 full assistance needed with oral care, resident previously able to complete oral care with verbal cueing. Currently unable to perform oral hygiene independently and at times refuses caregiver assistance, demonstrating resistance, and assistance with morning and bedtime dental care. LPA reviewed logs in place for new changes in R1 services needs.

Based on the information mentioned above, the Department is unable to ascertain if the allegation occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated.

An exit interview was conducted with Executive Director and a copy of this LIC9099 report was left at facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2