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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603729
Report Date: 04/24/2025
Date Signed: 04/24/2025 03:04:07 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
04/22/2025 and conducted by Evaluator Kimberly Ramirez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250422152151
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: 58DATE:
04/24/2025
UNANNOUNCEDTIME BEGAN:
08:01 AM
MET WITH:Administrator Daisy HernandezTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Facility staff do not provide adequate food service to residents.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced initial complaint investigation visit on 04/24/2025 regarding the above allegations. During today’s visit, LPA Ramirez was greeted by Business Office Director- Lachaun Gill 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 interviews#1-4 (S1 – S4), Resident Interviews#1-6 (R1 – R6), Copies of R1’s: Original Admission Agreement, Face Sheet, Physician’s Report (LIC 602A), Copies of: Easter Brunch Menu 2025, Easter Brunch Flyer dated 04/19/2025, Reconciliation roster of Easter Brunch meal (04/19/2025) purchased by resident’s loved ones, and physical plant tour.

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

DATE: 04/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2025
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-20250422152151
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: 04/24/2025
NARRATIVE
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The investigation revealed the following: regarding the allegation- “Facility staff do not provide adequate food service to residents.” It is alleged staff over salted food and did not provide quality food service to residents and their families on 04/19/2025. LPA Ramirez toured kitchen area and dinning room area during visit. LPA Ramirez observed facility walk in refrigerator temperature to read 40 degrees F, which is within regulation General Food Service Requirements- 87555(b)(21). LPA Ramirez observed stored food in containers to contain labels that indicated “preparation date and use by date” on all containers with food. Food was stored away from chemicals and cleaning sinks. LPA Ramirez did not observe spoiled food while inspecting perishable foods and non-perishable foods. LPA Ramirez observed kitchen staff wearing hair nets and using gloves while handling food during today’s visit. Four (4) out of the four (4) staff interviewed did not corroborate this allegation. One (1) out of six (6) residents interviewed corroborated this allegation. 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 during this investigation visit. Exit interview conducted. A copy of this report was provided via email.

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

DATE: 04/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2