306004595-6-27-2025-22-AS-LRIS-DJSVLD-20250721163147

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306004595
Report Date: 06/27/2025
Date Signed: 06/27/2025 01:38:54 PM

Unsubstantiated

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
03/04/2024 and conducted by Evaluator Arielle Pascua

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20240304094749

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:	0	CENSUS: 0	DATE:	06/27/2025
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Kathlenn Olson and Jon Champman		TIME COMPLETED:	01:20 PM

ALLEGATION(S):

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Facility does not have adequate staff to meet the needs of the residents.

INVESTIGATION FINDINGS:

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On 06/27/2025, Licensing Program Analyst (LPA) Arielle Pascua conducted a Microsoft Teams meeting with Facility Designated Administrators (FDAs), Kathleen Olson and Jon Champman for the purpose of delivering complaint findings for the allegation above.
A brief interview with FDAs Olson and Champman was conducted.
Allegation: Facility does not have adequate staff to meet the needs of the residents
It was alleged that the facility lacked adequate staffing to meet the needs of its residents. During the investigation, the Licensing Program Analyst (LPA) reviewed facility records and conducted staff and resident interviews.
Interviews were conducted with five staff members. All five acknowledged that staffing changes had occurred but were unable to recall whether these changes impacted their ability to meet residents' needs during March 2024. Each staff member stated that while some days were busier than others, they were still able to meet resident needs.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Emerita Curiel	TELEPHONE: (916) -26-4707
LICENSING EVALUATOR NAME: Arielle Pascua	TELEPHONE: 916-862-5907
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2025

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-20240304094749

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: 06/27/2025

NARRATIVE

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On 03/11/2024, LPA Saborit-Guasch also interviewed five residents. One resident reported that staffing was consistently inadequate, resulting in delays when requesting assistance. The remaining four residents reported no issues obtaining help when needed.
A review of the facility’s staffing records for March 2024 indicated that 13 care staff were listed on the roster. A comparison with payroll logs confirmed that these 13 staff members were compensated for their shifts. However, the payroll documentation only provided hours worked and did not specify exact shift times or dates.
Based on the information obtained through record reviews and interviews, there is insufficient evidence to substantiate the allegation that the facility lacks adequate staffing to meet resident needs.
As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred.
There were no deficiencies observed or cited at this time.
An Exit Interview was conducted and a copy of this report was provided to the facility via email. A certified copy will be sent to the facility mailing address.

SUPERVISOR'S NAME: Emerita Curiel	TELEPHONE: (916) -26-4707
LICENSING EVALUATOR NAME: Arielle Pascua	TELEPHONE: 916-862-5907
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2025

LIC9099 (FAS) - (06/04)

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