**Overview**
ActivCare at 4S Ranch, a 740‑type group home in San Diego, houses up to 60 older adults, many of whom are non‑ambulatory and some of whom are under a hospice waiver. Over the past two years the California Department of Social Services conducted several unannounced visits, including case‑management reviews in response to resident‑related incidents and the required one‑year compliance inspections.

**Resident‑Related Incidents and Deficiencies**
A series of adverse events involving Resident #1 (R1), who has dementia and uses a walker, prompted multiple inspections. R1 was found unconscious with head trauma on the night of 12/07/2021 and later died; an incident report and death certificate were filed. In November 2022, R1 left the facility unobserved and was returned by law enforcement after an approximate one‑hour absence; this AWOL event triggered a deficiency citation under 87705(c)(4) for inadequate direct‑care staffing for residents with dementia. A similar fall on 12/12/2022 resulted in R1’s death on 12/17/2022. In the 1/6/2023 case‑management visit, the deficiency was formally documented and a plan of correction was developed. Subsequent case‑management visits in 2021, 2022, and 2023 (1/18/2023) found no additional health or safety concerns and did not cite new deficiencies.

**Compliance and Annual Inspections**
The facility’s infection‑control program was evaluated during a 6/16/2022 unannounced inspection, where the Department confirmed full compliance with the COVID‑19 Mitigation Plan (LIC 808). A required one‑year inspection on 10/16/2023 likewise found the facility substantially compliant with Title 22 regulations, noting adequate staffing for its 56 current residents and proper physical security measures. The only documented shortfall remains the staffing level cited for dementia care in the January 2023 visit; the facility has been given a plan of correction to address this issue. Overall, the reports indicate that, aside from the noted deficiency, ActivCare at 4S Ranch maintains standard compliance with state regulations and has effectively managed the serious incidents that have occurred.