306005986-3-7-2026-22-AS-APAO-DSA6B8-20260317203931

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005986
Report Date: 03/07/2026
Date Signed: 03/07/2026 02:26:04 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
10/04/2023 and conducted by Evaluator Samer Haddadin

COMPLAINT CONTROL NUMBER: 22-AS-20231004123439

FACILITY NAME:	ACTIVCARE LAGUNA HILLS		FACILITY NUMBER:	306005986
ADMINISTRATOR:	SHETTER, TODD A.		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:	03/07/2026
		UNANNOUNCED	TIME BEGAN:	08:44 AM
MET WITH:	Patricia Miller		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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1-Staff left resident on the floor after a fall for a prolonged period of time
2-Staff do not assist residents with incontinence needs
3-Staff do not answer residents' call buttons in a timely manner
4-Staff do not ensure residents have adequate night time supervision

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced visit to the facility to investigate the above-mentioned allegations and deliver findings. Upon arrival, LPA was greeted by staff, granted entry, and later met with Executive Director (ED) Patricia Miller, to whom the purpose of the visit was explained.
During the visit, LPA toured the facility, interviewed staff and residents, and obtained copies of pertinent documents, including staff schedules, resident rosters, service request call button records, and staff training files.
It was alleged that “Staff left resident on the floor after a fall for a prolonged period of time” and “Staff do not assist residents with incontinence needs”. LPA conducted six staff interviews and attempted six resident interviews. All six staff members denied both allegations. The residents interviewed were unable to provide reliable statements due to their cognitive condition. {***CONTINUE 9099C***}

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2026

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-20231004123439

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: 03/07/2026

NARRATIVE

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During resident interviews, LPA did not observe any incontinence odor or unusual smell. Residents appeared clean, well-groomed, and hygienically maintained. In addition, record review showed that the facility conducts checks on residents every two hours and maintains a log of those checks. LPA also reviewed the Community Care Licensing (CCL) electronic log for any reported falls or Special Incident Reports (SIRs) involving Resident 1 (R1) and found no reported incidents or falls for R1.
It was also alleged that “Staff do not answer residents' call buttons in a timely manner” and “Staff do not ensure residents have adequate nighttime supervision”. All six staff members interviewed denied both allegations. In addition, according to the facility’s “Detailed Event Report” for the call button system, call requests were responded to in a timely manner and no calls were left unattended. LPA also tested the call button system during the visit and observed staff response within 0.54 seconds. Regarding nighttime staffing, facility records showed that at the time of the alleged incident, there were four caregivers and one nurse on duty during the overnight shift.
Based on observations, interviews, and record review, the Department is unable to determine that the allegations occurred as reported. Although the allegations may have happened or may be valid, there is not a preponderance of evidence to prove or disprove that the alleged violations occurred. Therefore, the allegations are deemed Unsubstantiated.
An exit interview was conducted with the Executive Director, and a copy of this LIC 9099 report was left at the facility.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2026

LIC9099 (FAS) - (06/04)

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