198602608-4-2-2026-28-AS-LHIS-DTBM96-20260420092411

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602608
Report Date: 04/02/2026
Date Signed: 04/02/2026 04:54:31 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/25/2026 and conducted by Evaluator Jewel Baptiste

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260325164747

FACILITY NAME:	IVY PARK AT CERRITOS		FACILITY NUMBER:	198602608
ADMINISTRATOR:	MARK PADILLA		FACILITY TYPE:	740
ADDRESS:	11000 NEW FALCON WAY		TELEPHONE:	(562) 865-9500
CITY:	CERRITOS	STATE: CA	ZIP CODE:	90703
CAPACITY:	163	CENSUS: 135	DATE:	04/02/2026
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Administrator Mark Padilla		TIME COMPLETED:	05:08 PM

ALLEGATION(S):

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Staff mismanaged resident's medications.
Staff did not communicate with resident's responsible party of medication changes.

INVESTIGATION FINDINGS:

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On 04/01/2026 at 08:00 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an initial complaint visit to investigate the above allegations. Upon arrival, LPA met the Maintenance Director, Maria Gallegos. The Administrator, Mark Padilla, arrived at 9:00 a.m., and the LPA explained the purpose of the visit.

During the visit, LPA interviewed the Administrator and a total of two (2) staff members, who shall be referred to as Staff #1 and #2 (S1-S2). LPA interviewed the nurse practitioner, who shall be referred to as Witness #1 (W1). LPA also interviewed a total of fourteen (14) residents, who shall be referred to as residents #1-14 (R1-R14). LPA Baptiste obtained the staff roster, the resident roster, R1’s physician’s report, R1’s Consonsus pharmacy provider waiver, preplacement appraisal information, Resident information form, R1 PRN medication ability determination, medication clarification form, charting notes, and a copy of R1’s physician’s orders. A file review and medication review were conducted for R1. Prior to the visit, LPA Baptiste attempted to contact R1’s physician and left a message.
Report continued on 9099c

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE:	DATE: 04/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20260325164747

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: IVY PARK AT CERRITOS	FACILITY NUMBER: 198602608
	VISIT DATE: 04/02/2026

NARRATIVE

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The investigation reveals the following: Regarding “Staff mismanaged resident's medications”. It is alleged that the facility removed R1’s prescribed Omeprazole and replaced it with a facility-provided version of the medication. It was found that R1 began receiving Omeprazole from the facility pharmacy after the Omeprazole they had moved in with ran out. This caused a change in the manufacturer and the medication's color, which alerted R1. During the file review, LPA determined that R1 consented to using the facilities' pharmacy rather than the pharmacy they had before moving in. R1 stated they don’t want to make any changes to the medication and will continue taking the medication provided by the facility. The administrator and 2 out of 2 staff stated they have given the medication as prescribed and can use another pharmacy if this is what R1 wants. W1 stated that both forms of Omeprazole have the same effect and that they have educated R1 on the topic. 13 out of 14 residents stated they either receive assistance with their medication or take it independently and have no issues with the facility.

The investigation reveals the following: Regarding “Staff did not communicate with the resident's responsible party of medication changes”. It is alleged that the facility has been providing the resident with a facility version of their prescribed medication without notifying the resident's responsible party. The administrator and both staff members stated that R1 does not have a Power of Attorney and that they are their own responsible party. They further stated there were no changes in the medication. R1 stated they were not informed of the medication change. File review confirmed that R1 is their own responsible party and that there were no changes to the medication. LPA also confirmed that R1 consented to using the facility pharmacy. 13 of 14 residents stated that the facility always updates them on any changes to their care.

Based on LPA's interviews, the investigation revealed: 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, therefore the allegation is UNSUBSTANTIATED.

An exit interview was conducted with Administrator Mark Padilla, and a copy of this record was provided.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
LICENSING EVALUATOR SIGNATURE:	DATE: 04/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2026

LIC9099 (FAS) - (06/04)

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