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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005986
Report Date: 05/19/2025
Date Signed: 05/19/2025 02:21:17 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
07/21/2022 and conducted by Evaluator Ruth Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20220721102237
FACILITY NAME:ACTIVCARE LAGUNA HILLSFACILITY NUMBER:
306005986
ADMINISTRATOR:SHETTER, TODD A.FACILITY TYPE:
740
ADDRESS:25200 PASEO DE ALICIATELEPHONE:
(858) 565-4424
CITY:LAGUNA HILLSSTATE: CAZIP CODE:
92653
CAPACITY:72CENSUS: 53DATE:
05/19/2025
UNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Patricia MillerTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Residents are left in soiled clothing for extended periods of time.
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 residents are left in soiled clothing for extended period of time. Interview with 3 of 3 staff stated that facility is a memory care facility, and most the residents wear a diaper, residents can get combative, but staff are trained to deescalate the behavior in order to assist resident with diaper changes.

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

DATE: 05/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2025
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-20220721102237
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: 05/19/2025
NARRATIVE
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Records review revealed that on July 26, 2022, facility census was 21 and out of the 21 there are 13 residents that wear diapers. End of shift reports does not reflect any resident’s unable to change diapers, however it does reflect residents to be combative, confused, not wanting to participate in activities, and not wanting to get dressed. Charting notes stated what was done to resolve the situation, notes do not reflect any resident to be unable to change their diaper.

Based on the information mentioned above, the Department is unable to ascertain if the allegation occurred as reported. Although the allegation 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: 05/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2