306005986-3-22-2026-22-AS-AORZ-DT7TEG-20260416143951

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005986
Report Date: 03/21/2026
Date Signed: 03/22/2026 11:04:28 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
02/24/2025 and conducted by Evaluator Samer Haddadin

COMPLAINT CONTROL NUMBER: 22-AS-20250224143848

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:	03/21/2026
		UNANNOUNCED	TIME BEGAN:	08:39 AM
MET WITH:	ED Patricia Miller		TIME COMPLETED:	04:10 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff do not safeguard residents personal clothing
Staff handled resident roughly causing a bruise

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

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, who was informed of the purpose of the visit. During the visit, LPA toured the facility, interviewed staff and residents, and obtained copies of relevant documents.
Regarding the allegation, “Staff do not safeguard residents personal clothing,” LPA conducted a phone interview with Resident 1’s responsible party (R1’s RP), who denied the allegation and stated that facility staff were helpful during R1’s stay. LPA also interviewed five staff members and attempted to interview five residents. All five staff members denied the allegation. The residents were unable to provide reliable statements due to their current medical and cognitive condition.
{***CONTINUE9099C***}

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2026

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-20250224143848

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: 03/21/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

In addition, LPA reviewed Resident 1’s records, including progress notes, admission records and the physician’s report, and did not identify any information supporting the allegation.
Regarding the allegation, “Staff handled resident roughly causing a bruise,” LPA interviewed five staff members and attempted to interview five residents. All five staff members denied the allegation and stated that staff do not handle residents in a rough manner. The residents were unable to provide reliable statements due to their current medical and cognitive condition. LPA also conducted a phone interview with Resident 1’s responsible party, who denied the allegation and stated that facility staff were helpful during R1’s stay. R1’s RP further reported that Resident 1 had fallen from the bed and that facility staff immediately arranged for Resident 1 to be sent to the hospital for evaluation. Facility records also showed that a Special Incident Report was submitted regarding an unwitnessed fall that occurred on February 24, 2025. The records further showed that Resident 1 was transported to the hospital, later discharged without serious injury, and placed on a 72-hour observation period by the facility.
Based on interviews, observations, and record review, the Department was 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 Executive Director (ED) Patricia Miller and a copy of this report was provided.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 2