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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603715
Report Date: 10/31/2025
Date Signed: 10/31/2025 03:52:56 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
10/24/2025 and conducted by Evaluator Noemi Galarza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20251024145312
FACILITY NAME:IVY PARK AT SAN MARINOFACILITY NUMBER:
198603715
ADMINISTRATOR:SANCHEZ, KIMBERLYFACILITY TYPE:
740
ADDRESS:8332 HUNTINGTON DRIVETELEPHONE:
(626) 292-7800
CITY:SAN GABRIELSTATE: CAZIP CODE:
91775
CAPACITY:74CENSUS: 57DATE:
10/31/2025
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Kimberly Sanchez, Executive DirectorTIME COMPLETED:
03:25 PM
ALLEGATION(S):
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Staff left resident on the ground for an extended period of time.
Staff are refusing to lift resident back up off the floor.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Galarza conducted an initial 10-Day complaint visit to investigate the allegations listed above. The purpose of the visit was explained to Kimberly Sanchez.

The investigation consisted of: A physical plant tour of the facility was conducted. Special focus of the Memory Care Unit operations was observed. A total of 7 staff and 9 residents were interviewed. Resident (R1's) file was reviewed. Copies of R1's Face Sheet, Physician's Report, Individualized Service Plan, Resident Assessment and charting notes were obtained. In addition, medical emergencies-calling 911 policy, Dementia Care Plan, fall incident reports in the last month, resident roster, and staff roster were obtained.

*Note an incident report for the alleged incident was not submitted to CCLD within 7 days. A case management report was generated to issue a citation for reporting requirements.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Noemi Galarza
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2025
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 2
Control Number 28-AS-20251024145312
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 SAN MARINO
FACILITY NUMBER: 198603715
VISIT DATE: 10/31/2025
NARRATIVE
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Allegation: Staff left resident on the ground for an extended period of time. It is alleged that on October 22, 2025 at approximately 10:00 PM, emergency personnel responded to a fall incident, in which resident (R1) was found sitting on the ground in the middle of the room next to their bed. It is unknown how long the resident was on the floor. The complaint alleges caretaker negligence because staff wait for fire department personnel to arrive on scene to complete a basic assessment. Emergency personnel deemed R1 oriented to name, age, city and when asked about pain and injury the resident denied injury. A total of nine (9) residents were interviewed. Three (3) of the residents interviewed recently fell. The residents stated staff respond and leave the residents on the floor until paramedics arrive in case there is broken bones or head injuries. A total of seven (7) staff were interviewed. Staff interviews revealed that resident (R1) is cognitively impaired and resides in the Memory Care Unit of the facility. According to staff, facility protocol in the Memory Care Unit is to call 911 if there is any accident involving a possible head injury, such as and un-witnessed fall. Staff stated that the PM care provider on duty did their last safety check prior to ending their shift at 10 PM, and found the resident sitting on the floor with cris crossed legs. The med-tech on duty was notified, and called 911. While waiting for emergency personnel med-tech assessed the resident by asking them questions and conducting a visual body check. All staff stated that since the resident has Dementia and is a fall risk the followed facility procedures that indicate whenever a Memory Care Unit resident falls they are to immediately call 911 because the residents are cognitively impaired and may not be able to express a change in condition. Based on file review of the Plan of Operation, facility policy regarding medical emergencies- calling 911, and R1's file documents, which indicate the resident is under fall management, there is insufficient evidence to support the allegation.

Allegation: Staff are refusing to lift resident back up off the floor. The complaint alleges facility staff called 911 emergency because they needed help in lifting resident (R1) after they fell. It is suspected the facility is using 911 for non-actual emergencies, and expected emergency personnel to lift and transport the resident to bed, even though R1 did not require medical treatment and was not going to be transported to a hospital for treatment. Resident interviews revealed that staff leave the residents on the floor when they sustain falls, and if they are not transported to a hospital staff lift the residents from the floor. All staff denied the allegation, and stated they did not ask emergency personnel to lift R1. They stated that they follow facility procedures that indicate they are to leave any resident that sustains an unwitnessed fall on the ground until emergency personnel assess the resident. Staff stated it is the care provider's responsibility to place a resident back on their bed or chair after they have fallen if they are not transported to the hospital. Staff stated they do not expect emergency personnel to assist with lifting residents if they are not transported. There is insufficient evidence to support the allegation.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.



An exit interview was conducted and a copy of this report was discussed and provided to Kimberly Sanchez.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Noemi Galarza
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2