306005351-2-27-2024-22-AS-AORZ-D39NH6-20240311102814

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005351
Report Date: 02/27/2024
Date Signed: 02/27/2024 02:39:07 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
02/22/2024 and conducted by Evaluator Kimberly Lyman

COMPLAINT CONTROL NUMBER: 22-AS-20240222131129

FACILITY NAME:	IVY PARK AT MISSION VIEJO		FACILITY NUMBER:	306005351
ADMINISTRATOR:	FOUDIL MANADI		FACILITY TYPE:	740
ADDRESS:	27783 CENTER DRIVE		TELEPHONE:	(949) 364-6210
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92692
CAPACITY:	150	CENSUS: 108	DATE:	02/27/2024
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Foudil Manadi		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff did not issue a proper eviction notice to resident in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate an investigation into the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit.
During the course of the investigation, LPA interviewed staff and resident as well as reviewed and obtained pertinent documentation such as eviction notice and facility notes. Regarding the allegation that staff did not issue a proper eviction notice to resident in care, the investigation revealed the following: On 06/08/2023, Resident 1 (R1) was provided a "Letter of Concern" by facility administrator. The letter was to address an incident of a narcotic being stored in the resident's room as well as inappropriate touching of staff members. The letter provided the verbiage from house rules that were being violated. On 02/05/2024, R1 was provided a 30 day eviction notice outlining multiple instances of inappropriate behavior towards staff. Per admission agreement, R1 signed the acknowledgement of house rules on 05/30/2023. LPA interviewed Administrator, five staff members as well as R1 during the investigation. All staff interviewed confirm inappropriate behaviors as outlined in the eviction notice and R1 CONTINUED ON LIC 9099C DATED 02/27/2024

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly Lyman	TELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024

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-20240222131129

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: IVY PARK AT MISSION VIEJO	FACILITY NUMBER: 306005351
	VISIT DATE: 02/27/2024

NARRATIVE

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admits to behavior that may have been misconstrued. Based on record review and interviews conducted, the department has determined the eviction notice was properly given. Therefore the allegation is deemed unfounded meaning the allegation is false could not have happened and/or is without a reasonable basis.

Exit interview conducted with Administrator and a copy of this report was left at the facility.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly Lyman	TELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2024

LIC9099 (FAS) - (06/04)

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