198603729-4-30-2026-28-AS-DSIS-DUJM6R-20260529092018

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603729
Report Date: 04/30/2026
Date Signed: 04/30/2026 06:13:25 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
04/24/2026 and conducted by Evaluator Gabriela Castro

COMPLAINT CONTROL NUMBER: 28-AS-20260424080523

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: 57	DATE:	04/30/2026
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Daisy Hernandez, Administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff did not follow proper eviction procedure
Staff do not serve residents food of good quality
Staff do not maintain facility in good repair
Staff did not report incidents to appropriate parties

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gabriela Castro conducted an unannounced complaint visit on 04/30/2026 to deliver findings related to the above allegation. LPA met with Administrator Daisy Hernandez and explained the purpose of the visit.

The investigation included a review of the client roster, staff roster, R1’s face sheet, R1’s Admission Agreement, Facility Notices related to reported incidents, Special Incident Reports (SIRs), and letters of concern issued to residents, maintenance logs, fire inspection reports, and documentation related to the elevator repair. LPA conducted interviews with four (4) staff members and six (6) residents. Information obtained through interviews and record review was used to assess the validity of the allegations. A facility walkthrough was conducted, including observation of resident bedrooms, common areas, the kitchen, and the overall food supply.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Gabriela Castro
LICENSING EVALUATOR SIGNATURE:	DATE: 04/30/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2026

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-20260424080523

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: IVY PARK AT CLAREMONT	FACILITY NUMBER: 198603729
	VISIT DATE: 04/30/2026

NARRATIVE

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Allegation: Staff did not follow proper eviction procedure

It is alleged that the facility did not follow proper eviction procedures when issuing R1 a 30-day eviction notice. Based on record review and interviews conducted, it was determined that R1 is his own responsible party; therefore, the facility is not required to notify an additional responsible party regarding the eviction. Record review indicates that R1 signed the Resident Admission Agreement on 11/05/2021, acknowledging understanding of facility policies. Article II, “Responsibilities and Representation of the Resident,” specifies that the resident shall not engage in disruptive behavior, create unsafe conditions, or physically or verbally abuse other residents or staff. Documentation further reflects that the facility provided multiple written notices and letters of concern to R1 addressing behavioral issues and expectations prior to issuing the eviction notice. These documents demonstrate that R1 was informed of ongoing concerns and expectations for compliance with facility rules. Additionally, based on review of the eviction notice, it was determined that the notice is consistent with Title 22 requirements.

Allegation: Staff do not serve residents food of good quality

It is alleged that the facility does not provide residents with food of good quality, including concerns that meals may be improperly prepared or contain spoiled or moldy items. During staff interviews, all staff denied concerns regarding food quality, including any reports of spoiled or moldy food. Staff stated that meals are prepared in accordance with proper food handling procedures and that any concerns raised are addressed immediately. Staff further reported that the facility conducts regular meetings to discuss dining services and address resident feedback. Resident interviews were consistent, with the majority of residents reporting satisfaction with the food and denying any observations of mold or spoiled meals. Additionally, LPA toured the facility kitchen and observed proper food handling and storage practices. All food items appeared to be in good condition, with no visible signs of spoilage.

Allegation: Staff Do Not Maintain Facility in Good Repair

It is alleged that the facility is not being properly maintained in good repair, including concerns related to the elevator not functioning and other potential maintenance issues within the facility. During staff interviews, staff reported that the facility is maintained in good repair. Staff acknowledged that the elevator experienced a temporary malfunction in March 2026; however, repairs were completed as soon as the necessary part was obtained. Staff further reported that residents were notified of the repair status and were assisted as needed during the outage. Documentation reviewed indicates that Community Care Licensing (CCL) was notified of the elevator malfunction. Staff indicated that the elevator is maintained every six (6) months, and maintenance logs were provided and reviewed. Additionally, a recent fire alarm inspection was conducted with no issues identified, and copies of the inspection records were observed. LPA conducted a walkthrough of the facility and observed the elevator to be operational. The fire alarm system was not activated at the time of the visit, and no issues were observed. During interviews, R1 and other residents reported no current concerns regarding the fire alarm system. (continued on 9099C)

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Gabriela Castro
LICENSING EVALUATOR SIGNATURE:	DATE: 04/30/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2026

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20260424080523

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: IVY PARK AT CLAREMONT	FACILITY NUMBER: 198603729
	VISIT DATE: 04/30/2026

NARRATIVE

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Allegation: Staff did not report incidents to appropriate parties
It is alleged that the facility failed to report incidents involving R1’s behavior to appropriate parties, including failing to document and communicate concerns as required. During staff interviews, staff reported that incidents involving R1’s behavior were documented and maintained in the resident’s file. Staff stated that notes were completed following incidents and that, when necessary, witnesses were present during interactions due to R1’s communication style. Staff also reported that multiple letters of concern were issued to R1 addressing behavioral issues and expectations. Record review corroborated staff statements, as documentation including incident notes, letters of concern, and related records were observed in the resident’s file. Additionally, it was determined that R1 is his own responsible party.

Based on the investigation conducted, which included interviews with staff and residents, as well as a review of relevant records, there was insufficient evidence to support the reported 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. Exit interview was held, and a copy of this report was provided.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Gabriela Castro
LICENSING EVALUATOR SIGNATURE:	DATE: 04/30/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2026

LIC9099 (FAS) - (06/04)

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