198603729-3-10-2026-28-AS-WSHO-DWWUPS-20260813154557

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603729
Report Date: 03/10/2026
Date Signed: 03/10/2026 01:38:45 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
03/03/2026 and conducted by Evaluator Glenn Trueman

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260303153942

FACILITY NAME:	IVY PARK AT CLAREMONT		FACILITY NUMBER:	198603729
ADMINISTRATOR:	HERNANDEZ, DAISY		FACILITY TYPE:	740
ADDRESS:	2053 NORTH TOWNE AVE		TELEPHONE:	(909) 398-4688
CITY:	CLAREMONT	STATE: CA	ZIP CODE:	91711
CAPACITY:	81	CENSUS: 59	DATE:	03/10/2026
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Staff S1		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Staff are not following infection control measures
Staff are not properly reporting incidents involving the residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Glenn Trueman conducted an unannounced initial complaint investigation visit on 03/10/2026 regarding the above allegations. During today’s visit, LPA Trueman was greeted by Staff S1 and explained the purpose of the visit. Administrator- Daisy Hernandez arrived shortly after.
The investigation consisted of the following: LPA Trueman requested and obtained copies of Resident Roster and Staff roster.
Staff interviews#1-7 (S1 – S7 ) and Resident Interviews#1-6 (R1 – R6) .Administrator interviewed.
Purchase Order dated 2/23/2026 for Rapid Multi Surface Disinfectant Cleaner 2/10/2026 and 2/23/2026
and 1/8/2026, was submitted along with receipts for Clorox Wipes 9/16/2025 and 3/4/2026,
Purchase Orders for Super Santi Cloth Wipes 1/8/2026, 2/10/2026 were submitted.
In regards to the allegation Staff are not following infection control measures, based on interviews conducted and information gathered Administrator and 7 of 7 staff all stated they washed their hands for 20 seconds, used masks and gloves. Also said that they used EPA approved Rapid Multi Surface Disinfectant Cleaner and EPA approved Clorox wipes.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2026

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-20260303153942

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 CLAREMONT	FACILITY NUMBER: 198603729
	VISIT DATE: 03/10/2026

NARRATIVE

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All stated that Housekeeping thoroughly cleaned all resident rooms and common areas with EPA approved spray and wipes.
Also used sanitizer and also cleaned equipment.
LPA reviewed Purchase Orders for Rapid Multi Surface Disinfectant Cleaner 2/10/2026, 2/23/2026
and 1/8/2026, which were submitted along with receipts for Clorox Wipes 9/16/2025 and 3/4/2026,
Purchase Order for Super Santi Cloth Wipes 1/8/2026, 2/10/2026 was also reviewed.

Staff S7 stated that the facility always had EPA approved spray and Clorox wipes and stated that there was an e-mail exchange with Department of Health Representative in which the facility stated they already have been using EPA approved wipes and spray. LPA confirmed the e-mail exchange.
Interviews with Resident's R1- R6 who all stated that there was a virus going around. All stated that staff did a great job and they observed staff constantly cleaning and wiping down all areas.
Stated that housekeeping were doing a good job too cleaning rooms and other areas in the facility.
Said they all observed staff constantly washing their hands and staff would always tell them too to wash thier hands for 20 seconds.
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.

In regards to the allegation, Staff are not properly reporting incidents involving the residents based on interviews conducted and information gathered it was revealed by the Department of Health Representative that the facility staff who handles reporting any incident did send it in immediately on Monday 2/23/2026 and that there was not a problem with reporting.

Staff all stated that the incident was reported immediately by the Health Services Director.

Administrator stated that it was immediately reported. It was Record ID # 116 on 2/23/2026.

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.

Exit interview conducted and copies provided.

SUPERVISORS NAME: Wei Siew Ho
LICENSING EVALUATOR NAME: Glenn Trueman
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2026

LIC9099 (FAS) - (06/04)

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