Activcare at Yorba Linda.

Staff interviewed stated that R1 sustained some falls due to R1 attempting to transfer herself, even though she required assistance with transferring. Staff interviewed also stated that the facility put fall prevention methods in place for R1. The fall prevention methods put in place for R1 included a lowered bell, a fall mat, a tab alarm, and additional routine checks. Additionally, staff interviewed stated that R1 did not sustain any injuries from her falls at the facility. Although R1 sustained falls while at the facility, staff interviewed confirmed that fall prevention techniques were put in place to deter future falls, and prevent any serious injuries. Regarding the allegation, facility forcing resident to take medications, the following has been concluded: It was alleged that R1 was forced to take medications. The Department conducted an interview with R1. However, R1 was unable to provide a statement regarding this allegation. The Department conducted seven resident interviews. One resident was unable to be qualified for an interview and another resident declined to be interview. However, five out of the seven residents interviewed denied the allegation and stated that they have never been forced to take any medications. The Department conducted four staff interviews. Four out of the four staff interviewed denied the allegation and stated that R1 was never forced to take any medications. Regarding the allegation, facility not allowing resident access to their bedroom, the following has been concluded: It was alleged that the facility did not allow R1 access to her bedroom. The Department conducted an interview with R1. However, R1 was unable to provide a statement regarding this allegation. The Department conducted four staff interviews. One out of the four staff interviewed was unable to recall any information about this allegation. However, three out of the four staff interviewed denied the allegation. Staff interviewed stated that R1 was encouraged to be in the main activity room so that she could be observed by more staff since she had a history of falls at the facility. Staff interviewed also stated that they would assist R1 to her bedroom if she requested to go there. The Department conducted seven resident interviews. One resident was unable to be qualified for an interview and another resident declined to be interview. However, five out of the seven residents interviewed denied the allegation and stated that they are allowed to go to their bedrooms whenever they want to. Regarding the allegation, facility administering medication without obtaining consent from resident's responsible party, the following has been concluded: It was alleged that the facility administered R1's PRN Ativan medication without obtaining consent from R1's responsible party. CONTINUED ON LIC9099-C 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 Regarding the allegation, facility not providing a variety of meals to resident, the following has been concluded: The Department conducted seven resident interviews. One resident was unable to be qualified for an interview and another resident declined to be interview. However, five out of the seven residents interviewed denied the allegation. Residents interviewed stated that they are satisfied with the food provided by the facility. Residents interviewed also confirmed the facility provides alternative food options if they do not like the meals that are served on that day. The Department conducted four staff interviews. Four out of the four staff interviewed denied the allegation and confirmed the facility provides alternative food options if residents are not satisfied with the meals that are served on that day. The Department inspected the food menu provided to residents and observed the facility provides a variety of food options to residents. The Department also observed that residents are able to order off of the alternative menu if they are not satisfied with the food options served on that day. Based on the evidence gathered during this investigation, the complaint is UNFOUNDED, meaning that the two allegations are false, could not have happened and/or is without reasonable basis. An exit interview was conducted with Executive Director Enrique Ledesma and a copy of the report was provided. 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 The Department conducted an interview with R1. However, R1 was unable to provide a statement regarding this allegation. The Department conducted four staff interviews. One out of the four staff interviewed was recall any information about this allegation. However, three out of the four staff interviewed denied the allegation. Staff interviewed stated that consent was received from R1's responsible party regarding R1's PRN Ativan medication. The Department was unable to review any medication administration records for R1 due to R1 moving out of the facility on September 19, 2022. Additionally, the facility no longer has any records for R1 on the premises. Due to the conflicting information received during the investigation, the Department is unable to ascertain if the allegations 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, the four allegations are deemed UNSUBSTANTIATED. An exit interview was conducted with Executive Director Enrique Ledesma and a copy of the report was provided.

On November 21, 2024, at 9:15am, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced Case Management Visit to follow-up on an incident report that was self reported from the facility. LPA Kim was greeted and granted entry by staff. LPA explained the purpose of the visit to Marketing Director Shannen Buckholz. During today’s visit, LPA conducted a health and safety check, and there were no imminent health/safety concerns observed. Facility maintained at a comfortable temperature for the residents in care. LPA obtained Staff Roster, Resident Roster, and R1’s records which includes the Physician’s Report, Admission’s Agreement, Emergency Information, Consent Forms, Incident Reports, and Appraisal and Needs/Service Plan. LPA conducted three staff interviews and attempted two staff phone interviews. No deficiencies were observed during this visit. An exit interview was conducted, and a copy of this report was provided to the Marketing Director Shannen Buckholz.

On July 18, 2024 around 8:25AM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim met with Executive Director (ED) Enrique Ledesma and explained the purpose of the visit. The facility is licensed to operate for sixty (60) non-ambulatory, of which 15 may be bedridden, and have a hospice waiver for fifteen (15) residents. Facility is approved for delayed egress and secure perimeter, and a waiver for locked perimeter gates. The facility is a single-story structure, which consists of the following: fifty-three (53) resident bedrooms, six (6) office rooms, thirty-eight (38) bathrooms, waiting area, activity area, dining room, kitchen, and two (2) outdoor covered patio areas. LPA Kim toured indoor and outdoor of the physical plant with ED Ledesma. There are no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. The following bedrooms were inspected: Resident Room 101, Resident Room 106, Resident Room 206, Resident Room 209, Resident Room 306, Resident Room 307, Resident Room 310, Resident Room 401 and Resident Room 409. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured between 107.2 degrees F and 114.9 degrees F. A comfortable temperature of 74 degrees F was maintained in the facility. LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to clients. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. Evaluation Report Continues on LIC 809-C 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 During the visit, LPA Kim observed the facility's infection control practices. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). Emergency food is stored in the kitchen. Emergency water and emergency supplies were stored in a storage closet. A working telephone (714-577-8005) remains available. LPA Kim reviewed the facility’s plan of operation, emergency and disaster plan, and fire/safety drill log. The facility conducted a Fire/Safety Drill on April 22, 2024. The facility has eleven (11) fire extinguishers that are charged and they were all serviced on September 22, 2023, smoke detectors, and carbon monoxide detectors were operable and last checked on November 7, 2023. First Aid was maintained and contained all the necessary elements. LPA Kim conducted an audit of ten (10) resident files (R1-R10), eight (8) staff files (S1-S8), and medication and medication administration record were all in order and complete. LPA conducted three (3) resident interviews and seven (7) staff interviews. A Technical violation was assessed during this inspection visit according to the California Code of Regulations (Title 22, Division 6, Chapter 8). An exit interview was conducted, and a copy of this report was provided to Executive Director Enrique Ledesma.