<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603729
Report Date: 04/03/2025
Date Signed: 04/03/2025 02:38:04 PM

Unsubstantiated


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
03/27/2025 and conducted by Evaluator Kimberly Ramirez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250327102043
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:
04/03/2025
UNANNOUNCEDTIME BEGAN:
08:17 AM
MET WITH:Administrator Daisy HernandezTIME COMPLETED:
03:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff are not properly addressing pest infestation in facility.
Facility staff do not provide adequate food service to residents.
Facility staff do not ensure that residents are delivered hot water throughout the facility.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced initial complaint investigation visit on 04/03/2025 regarding the above allegations. LPA Ramirez identified herself to concierge desk upon entry and requested to speak with facility Administrator. LPA Ramirez was greeted by Marketing Director Heather Moore and explained the purpose of the visit. Administrator Daisy Hernandez arrived shortly after to assist with tour.

The investigation consisted of the following: LPA Ramirez requested and obtained copies of Resident/Client Roster, Staff roster, Staff#1 - 4 interviews (S1 – S4), Resident#1-5 (R1- R5), copies of R1’s: face sheet, physician’s report, physician’s orders, Ecolab pest control services contract, Ecolab service report dated 3/11/25, facility charting notes for R1, and physical plant tour.

See 9099-C for continued report.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2025
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-20250327102043
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: 04/03/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The investigation revealed the following: regarding the allegation(s)- Facility staff are not properly addressing pest infestation in facility. It is alleged the facility has a mice and rodent infestation throughout the facility. Four (4) out of the four (4) staff interviewed did not corroborate this allegation. One (1) out of the five (5) residents interviewed corroborated this allegation. LPA inspected physical plant including kitchen, pantry, residents’ rooms, lobby, dining room, visitor bathrooms, memory care unit and outdoor patio. LPA did not observe any health and safety violations. LPA reviewed facility pest control contract services with Ecolab. According to pest control service contract reviewed, pest control services are performed monthly throughout the facility. LPA reviewed service report dated 3/11/25 (start time 9:38am- end time 10:56am), it revealed no rodent, no fly, no ant, and no cockroach activity was found during inspection. 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.

Facility staff do not provide adequate food service to residents. It is alleged staff do not provide good quality food. Four (4) out of the four (4) staff interviewed did not corroborate this allegation. One (1) out of the five (5) residents interviewed corroborated this allegation. LPA inspected physical plant including kitchen, pantry, walk-in refrigerator, walk in freezers and dining room. LPA did not observe any health and safety violations. LPA observed kitchen staff wearing gloves while handling food and wearing hair nets. LPA observed perishable foods to contain labels that indicate discard date. LPA did not observe perishables to be spoiled or contain mold. Canned goods and dry foods stored in pantry contained labels that indicate discard dates. 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.

Facility staff do not ensure that residents are delivered hot water throughout the facility. It is alleged facility staff do not maintain hot water temperatures in grooming areas, in the early morning hours. Four (4) out of the four (4) staff interviewed did not corroborate this allegation. One (1) out of the five (5) residents interviewed corroborated this allegation. LPA inspected random resident rooms to inspect, shared/visitor bathrooms throughout the facility and kitchen area. Water temperatures in grooming areas tested to be within 105 – 120 degree F. 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.

No violations were observed or cited during this complaint investigation. Exit interview was conducted. A copy of this report was provided via email due to printer malfunction.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2