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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005351
Report Date: 03/19/2025
Date Signed: 03/20/2025 07:05:22 AM

Document Has Been Signed on 03/20/2025 07:05 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 VIEJOFACILITY NUMBER:
306005351
ADMINISTRATOR/
DIRECTOR:		FOUDIL MANADIFACILITY TYPE:
740
ADDRESS:27783 CENTER DRIVETELEPHONE:
(949) 364-6210
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92692
CAPACITY: 150TOTAL ENROLLED CHILDREN: 0CENSUS: 116DATE:
03/19/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:24 AM
MET WITH:Foudil ManadiTIME VISIT/
INSPECTION COMPLETED:
04:25 PM
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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to Ivy Park at Mission Viejo. The purpose of today’s visit was to conduct the annual required inspection. LPA was allowed entry into the facility and explained the reason for the visit. Facility is licensed for 150 non-ambulatory residents. Facility has an approved hospice waiver for 50 residents and the facility has 80 residents in assisted living and 36 in memory care. There are 8 residents on hospice. Administrator Foudil Manadi has an administrator certificate expiring on 01/28/2027

LPA Lyman along with Administrator Manadi toured the facility at 11:02 AM. LPA toured the physical plant, checked food service, facility records and the first aid kit. The facility consists of two stories in the main building including a library, bistro, cinema room, game room and hair salon. Memory care is a single story detached building. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 106.1 degrees F and 114.8 degrees F in all restrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Emergency pull cord response times were under five minutes. Common areas were clean and clear of hazards, doorways were free of obstructions. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Facility had posted appliance temperatures and all were in range. Dining room has varied menu choices for residents. Smoke detectors and fire/ sprinkler inspections are conducted by a third party, Quick Response Fire Protection with the last inspection on 01/01/2025. Fire extinguishers were fully charged. LPA reviewed the emergency disaster plan and plan is thorough and complete. Facility conducts emergency drills with the last drill conducted on 03/04/2025. LPA observed ample emergency food and water. Outside grounds were toured. LPA observed outside patio areas for both assisted living and memory care. There is ample outdoor shaded seating for residents. Walkways around the facility were clear of hazards. There are no security bars or weapons on the premises. LPA observed residents participating in exercise and movies and facility offers an array of activities including outings in the community. CONTINUED ON LIC 809C DATED 03/19/2025

Alisa OrtizTELEPHONE: (714) 703-2855
Kimberly LymanTELEPHONE: (714) 795-1497
DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/19/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 03/19/2025
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First aid kit contained all required items including tweezers, scissors and thermometer. LPA reviewed ten resident files and six staff files. All resident files contained required documentation including admission agreements, physician reports, resident appraisals, and physician orders for bed rails as indicated. Staff files reviewed contained required documentation including required annual training, medical assessment, criminal record clearance and proof of CPR training. At 3:00 PM, LPA reviewed medication administration and storage. Medications are stored in locked medication carts and facility utilizes an electronic medication administration record. Medications are being administered per physician order.









Based on the observations made during today's visit, NO deficiencies are being cited. Exit interview conducted and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly LymanTELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025
LIC809 (FAS) - (06/04)
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