Inspection Reports for ActivCare 4S Ranch

An unannounced, required annual inspection was conducted to evaluate compliance with licensing requirements for the facility.

The facility was found to be clean, sanitary, and in good repair with no deficiencies cited. Resident rooms, safety equipment, and emergency preparedness were all compliant. Interviews and record reviews revealed no regulatory concerns.

An unannounced complaint investigation was conducted in response to an allegation that staff left a resident on the floor after a fall.

The investigation found no evidence to support the allegation; the resident was observed crawling voluntarily and was not left unattended after a fall. The complaint was unsubstantiated.

The complaint alleged that staff left Resident 1 on the floor after a fall on October 27, 2024. Interviews and record reviews showed Resident 1 chose to crawl and was not injured or left unattended. The allegation was unsubstantiated.

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An unannounced required annual inspection was conducted to evaluate compliance with licensing requirements for the facility.

The facility was found to be clean, sanitary, and in good repair with no deficiencies observed or cited during the inspection. All required safety measures, equipment, and postings were present and in order.

An unannounced required one-year inspection was conducted to ensure substantial compliance with Title 22 regulations.

The facility was found to be in substantial compliance with regulations, with operational safety features, sanitary conditions, proper food storage, adequate staff certifications, and resident dignity maintained throughout the visit.

An unannounced Case Management visit was conducted by the Licensing Program Analyst to secure report signatures and deliver an amended report.

The Licensing Program Analyst identified himself, explained the purpose of the visit to the Executive Director, secured report signatures, delivered an amended report, and conducted an exit interview with the Executive Director.

The visit was an unannounced Case Management inspection conducted in response to an Incident Report and a Death Certificate submitted for Resident #1, who sustained a fall and subsequently passed away.

No health and safety concerns were identified and no deficiencies were cited during the visit. A tour of the facility was conducted and pertinent records were secured.

The visit was initiated to cite a deficiency in response to a self-reported incident where a resident was absent without leave (AWOL) from the facility and returned by local law enforcement on the same day.

A deficiency was cited for failure to ensure an adequate number of direct care staff to support residents, evidenced by the AWOL incident involving one resident who left the facility unobserved and was absent for approximately one hour.

The visit was complaint-related due to a self-reported incident of a resident absent without leave (AWOL) on November 29, 2022. The resident was returned by law enforcement the same day. No injuries were reported.

The inspection was an unannounced Required 1-Year Visit conducted to evaluate the facility's compliance with licensing requirements and infection control practices.

The Licensing Program Analyst observed the facility's implementation of the COVID-19 Mitigation Plan and infection control measures, finding the facility in compliance with no deficiencies noted during the visit.

The visit was an unannounced Case Management Visit to follow up on events self-reported by the licensee, specifically regarding an unusual incident and death report involving a resident.

The Licensing Program Analyst toured the facility, performed welfare checks, and reviewed pertinent care records. The case requires further investigation, and no deficiencies were cited during this visit.

The visit was triggered by an LIC624 Unusual Incident Report and an LIC624A Death Report concerning Resident #1, who was found deceased with head trauma after being last seen two hours earlier. The reports were self-reported by the licensee.

Licensing Program Analyst Laarni Santiago visited the facility to conduct an annual required licensing inspection.

The inspection verified compliance with infection control practices including COVID-19 mitigation measures. No deficiencies were cited during the visit.