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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198204069
Report Date: 11/21/2025
Date Signed: 11/21/2025 02:15:21 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/17/2025 and conducted by Evaluator Bernadette Allen
COMPLAINT CONTROL NUMBER: 11-AS-20251117102758
FACILITY NAME:IVY PARK AT SANTA MONICAFACILITY NUMBER:
198204069
ADMINISTRATOR:CLIFTON DOUYONFACILITY TYPE:
740
ADDRESS:1312 15TH STTELEPHONE:
(310) 899-1976
CITY:SANTA MONICASTATE: CAZIP CODE:
90404
CAPACITY:100CENSUS: DATE:
11/21/2025
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Clifton Douyon-Administrator TIME COMPLETED:
02:25 PM
ALLEGATION(S):
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9
Licensee does not ensure that residents are able to sleep at night
Licensee does not ensure facility plumbing is maintained in good repair
INVESTIGATION FINDINGS:
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On 11/21/2025, at 9:45AM, Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to conduct a complaint investigation and deliver findings for the alleged allegations. LPA identified herself and met Clifton Douyon -Administrator who was informed of the purpose of the visit.

On 11/21/2025 LPA requested and obtained a staff roster dated 8/27/2025 and resident roster dated 11/19/2025. LPA conducted interviews with staff members 1-5 (S1-S5) and Residents 1-8 (R1-R8). LPA requested copies of the following documents for Resident 1(R1) admissions agreement dated 6/30/2025, customer agreement dated 7/7/2025, physicians report dated 6/23/2025, plumbing invoice for repairs dated 10/6/2025 and 10/18/2025, and proof of credit/refund for inconvenience for R1 dated 10/16/2025, email correspondence between residents and/or responsible parties regarding renovations being conducted with details of changes, projected timeline, and floor order of work dated 9/23/2025,10/24/2025 and a copy of the Notice dated 9/23/2025. LPA also toured the facility and observed renovations had been done throughout the facility painted walls and new carpet/flooring.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2025
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 3
Control Number 11-AS-20251117102758
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: IVY PARK AT SANTA MONICA
FACILITY NUMBER: 198204069
VISIT DATE: 11/21/2025
NARRATIVE
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The investigation consisted of the following:

Allegation 1: Licensee does not ensure that residents are able to sleep at night

On 11/21/2025 LPA conducted interviews with staff members 1-5 (S1-S5) and 5 out of 5 staff members stated residents and their responsible parties were informed verbally and by correspondence/email and also provided with the executive director update notice dated 9/23/2025 of the renovations being conducted with details of changes, projected timeline, and floor order of work dated 9/23/2025. Staff also acknowledged some residents did have complaints but understood, under the circumstances, and were made aware of the community cosmetic updates being done.

The interviews with Resident 1-8 (R1-R8). LPA attempted to interview R1 and they no longer reside at the facility, R2 stated that they could not remember anything and R3 was on their way to an appointment and was unwilling to talk. The interviews with R4, R5, R6, R7 and R8 stated that they couldn’t remember getting a notice informing them of the renovations but when they were shown the executive director update notice dated 9/23/2025 and 5 out of 5 residents acknowledged seeing it throughout the facility and they did recall being informed verbally on several occasions about changes being made inside the facility. R4-R8 also acknowledged their sleep had been interrupted at times but understood it was because of the updates being done inside the facility.

Allegation 2- Licensee does not ensure facility plumbing is maintained in good repair

On 11/21/2025 LPA conducted interviews with staff members 1-5 (S1-S5) and 5 out of 5 staff members stated when plumbing issues occur in the building the plumber is called and scheduled for service. LPA also observed documentation of the plumbing service conducted on 10/6/2025 and 10/18/2025 including correspondence confirming relocation of R1 into another room along with refund/credit for inconvenience.



The interviews with Resident 1-8 (R1-R8). LPA attempted to interview R1 and they no longer reside at the facility, R2 stated that they could not remember anything and R3 was on their way to an appointment and unwilling to talk. The interviews with R4, R5, R6, R7 and R8 stated that they have not had any problems with plumbing in their rooms.
Continued .....
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20251117102758
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: IVY PARK AT SANTA MONICA
FACILITY NUMBER: 198204069
VISIT DATE: 11/21/2025
NARRATIVE
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Based on interviews, documents reviewed and observation during the investigation, the above allegation is found to be Unsubstantiated; meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.


An exit interview was conducted where this report was discussed and provided to Clifton Douyon - Administrator at conclusion of the visit with appeal rights. Clifton was unavailable to sign the report but Solaange Nkafu was authorized to sign the report
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3