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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603729
Report Date: 03/11/2025
Date Signed: 03/11/2025 04:17:30 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
03/04/2025 and conducted by Evaluator Kimberly Ramirez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250304162038
FACILITY NAME:IVY PARK AT CLAREMONTFACILITY NUMBER:
198603729
ADMINISTRATOR:HERNANDEZ, DAISYFACILITY TYPE:
740
ADDRESS:2053 NORTH TOWNE AVETELEPHONE:
(909) 398-4688
CITY:CLAREMONTSTATE: CAZIP CODE:
91711
CAPACITY:81CENSUS: 59DATE:
03/11/2025
UNANNOUNCEDTIME BEGAN:
11:12 AM
MET WITH:Administrator Daisy HernandezTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff are not following proper infection control practices at the facility.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced initial complaint investigation visit on 03/11/2025 regarding the above allegation. Staff from The California Department of Public Health joined LPA Ramirez for this investigation visit. LPA was greeted by Administrator Daisy Hernandez and explained the purpose of the visit.

The investigation consisted of the following: LPA Ramirez requested and obtained copies of Resident/Client Roster (LIC 9020), Staff#1 - 2 interviews (S1 – S2), Interview with staff from The California Department of Public Health (CDPH), copy of facility Coronavirus/COVID-19 Preparedness and Response Plan, copy of facility Infection Control Polices, copy of County of Los Angeles Official Inspection Report dated 03/04/2025, and physical plant tour.

See 9099-C
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025
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 28-AS-20250304162038
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: IVY PARK AT CLAREMONT
FACILITY NUMBER: 198603729
VISIT DATE: 03/11/2025
NARRATIVE
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The investigation revealed the following. Regarding Allegation: Staff are not following proper infection control practices at the facility – It is alleged facility staff did not follow infection control practices during an active infectious outbreak beginning on 2/23/2025. On 02/23/2025, facility staff reported to this licensing agency and to The California Department of Public Health (CDPH), that the facility had five (5) residents that had tested positive for COVID-19. Staff interviews revealed that on 02/24/2025, CDPH placed the facility on surveillance due to an active epidemic outbreak of COVID-19. On 02/27/2025, CDPH recommended the facility suspended communal dining and activities during an outbreak. Staff interviews conducted by LPA Ramirez revealed, communal dining was not suspended but residents that tested positive, self-isolated. According to the facility’s Coronavirus/COVID-19 Preparedness and Response Plan, I. “Upon widespread market-based transmission or suspected exposure within the community the following quarantine interventions will be followed: 5. Meals will be delivered to apartments, in accordance with Culinary Virus Protocol procedures.” On 03/04/2025, CDPH issued a violation for “COVID-19 Employees Face Cover Required”. County of Los Angeles Official Inspection Report dated 03/04/2025, revealed multiple staff were observed to be unmasked while walking indoors in common areas. According to the facility’s Coronavirus/COVID-19 Preparedness and Response Plan, I. “Upon widespread market-based transmission or suspected exposure within the community the following quarantine interventions will be followed: 2. All team members will wear med-surg masks within the community.” According to the facility’s Coronavirus/COVID-19 Preparedness and Response Plan, Steps of Community Reopening Plan, Step 1: Reopen the salon and indoor visits if: Request letter to the county has been submitted and no obligations have been raised and there have been no positive COVID residents or staff at the community for at least the past 14 days. There are no residents or staff suspected with COVID-19. Step 2: Resume limited communal dining and small group activities if 14 days have passed since Step began and there have been no positive COVID residents or staff and there are no residents or staff suspected with COVID-19. Staff interviews revealed, the last resident or staff to test positive for COVID-19 was on 02/26/2026. On 03/11/2025, LPA Ramirez observed several residents utilizing the dining room for activities and dining, even though the facility is in an active epidemic outbreak. Based on interviews, observations, and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated.

One (1) type A violation was cited during this complaint investigation. Exit interview was conducted. A copy of this report, 9099-D and appeals rights was provided.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20250304162038
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: IVY PARK AT CLAREMONT
FACILITY NUMBER: 198603729
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/11/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
03/12/2025
Section Cited
CCR
87465(a)(9)
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Incidental Medical and Dental Care
(a)A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following:
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The licensee did not ensure infection control practices were maintained during an active epidemic outbreak. Administrator will certify plan for re-training by 3/12/2025. Proof of re-training must be completed and sent to LPA Ramirez by 3/25/2025.
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(9) The licensee shall ensure that infection control practices are maintained in the facility as specified in Section 87470, Infection Control Requirements.
The licensee did not meet these requirements as evidenced by:
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3