306004595-8-21-2024-22-AS-LMOA-D8M9U5-20240829234010

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004595
Report Date: 08/21/2024
Date Signed: 08/21/2024 09:10:34 AM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/23/2024 and conducted by Evaluator Jessica Cho

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20240223085739

FACILITY NAME:	IVY PARK AT FULLERTON		FACILITY NUMBER:	306004595
ADMINISTRATOR:	CHRISTIAN OTBO		FACILITY TYPE:	740
ADDRESS:	2226 N EUCLID ST		TELEPHONE:	(714) 738-3656
CITY:	FULLERTON	STATE: CA	ZIP CODE:	92835
CAPACITY:	85	CENSUS: 50	DATE:	08/21/2024
		UNANNOUNCED	TIME BEGAN:	07:00 AM
MET WITH:	Christina Hale- Executive Director Martha Reynolds- Regional Health Services Director Miguel Silva - and Health Service Director		TIME COMPLETED:	09:10 AM

ALLEGATION(S):

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Facility is not following resident's special diet.
Facility is not providing cutlery to residents in care.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Jessica Cho, Edward Kim, and Samer Haddadin made an uannounced subsequent visit for the purpose of continuing the investigation into the above allegations. At 7:15am, LPAs were greeted and granted entry by Maintenance Director Alejandro Santana and explained the reason for the visit. Executive Director (ED) Christina Hale was also advised of the visit by telephone.

On February 23, 2024, LPA Cho initiated the complaint investigation. During the course of the investigation, LPA toured the facility with ED Hale and observed the following: The facility is a two-story building comprised of an Assisted Living (on the 1st/2nd floors) and Memory Care Unit (on the 2nd floor). LPA observed the facilty to be clean and sanitary. Residents appeared to be well taken care of and were observed participating in activities as well as relaxing in their rooms and common areas. LPA observed all common areas to be clean and operational. LPA also observed the kitchen had ample food supply. There were no health and safety concerns observed at the time of the visit.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Lourdes Montoya	TELEPHONE: (714) -70-2870
LICENSING EVALUATOR NAME: Jessica Cho	TELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2024

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 22-AS-20240223085739

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: IVY PARK AT FULLERTON	FACILITY NUMBER: 306004595
	VISIT DATE: 08/21/2024

NARRATIVE

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Regarding the allegation, facility is not following the resident's special diet, it was determined after interviewing ED Christina Hale and Regional Health Services Director (RHSD) Martha Reynolds, that Resident #1 (R1) is/was not an existing resident residing at this facility. In an email received from RHSD Reynolds on February 23, 2024, the company was unable to locate R1 and had no records found in the PointClick Care database.

Regarding the allegation, facility is not providing cutlery to residents in care, LPAs observed on today's date that residents were observed using cutlery during breakfast at 7:42am.

Therefore, this agency has investigated the complaint and based on the observations made, interviews which were conducted and the records that were reviewed, the following allegations, Facility is not following resident's special diet and Facility is not providing cutlery to residents in care, is deemed UNFOUNDED. We have found that the complaint was unfounded, meaning that the allegations were false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

An exit interview was conducted with Executive Director Christina Hale, Regional Health Services Director, Martha Reynolds, and Health Service Director Miguel Silva, and a copy of this report was provided at the end of the visit.

SUPERVISOR'S NAME: Lourdes Montoya	TELEPHONE: (714) -70-2870
LICENSING EVALUATOR NAME: Jessica Cho	TELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2024

LIC9099 (FAS) - (06/04)

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