306005351-4-6-2026-22-AS-KSGH-DTN2LS-20260430173001

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005351
Report Date: 04/06/2026
Date Signed: 04/06/2026 02:04:58 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
01/12/2024 and conducted by Evaluator Jessica Cho

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20240112171918

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: 125	DATE:	04/06/2026
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Joan Shattler- Business Office Director		TIME COMPLETED:	02:25 PM

ALLEGATION(S):

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Staff does not treat residents with dignity and respect.
Staff does not assist residents with toileting.
Residents' hygiene needs are not being met.
Facility does not have adequate staffing to meet residents' needs.

INVESTIGATION FINDINGS:

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On April 6, 2026, Licensing Program Analyst (LPA) Jessica Cho made an unannounced visit for the purpose of continuing the investigation into the above allegations. LPA met with Business Officer Director (BOD) Joan Shattler and stated the reason for the visit. On January 12, 2024, the Department received the complaint. The complaint investigation was initiated on January 18, 2024. During the course of the investigation, LPA conducted a walk through of the memory care unit and successfully interviewed six of seven residents since one resident was preoccupied at the time of the interview. LPA also interviewed three staff and obtained the following resident documentation for review: Resident Rosters, Personnel Reports, Face Sheets with photos, Medical Assessments (LIC 602s), and Individualized Service Plans (ISPs).

The following was determined: Regarding the allegation, Staff does not treat residents with dignity and respect, it is alleged that the caregivers laughed instead of helping a memory care resident who was witnessed walking on all fours across the dirty floor. It was reported that there were a number of instances where the caregivers were seen laughing.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 22-AS-20240112171918

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 MISSION VIEJO	FACILITY NUMBER: 306005351
	VISIT DATE: 04/06/2026

NARRATIVE

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Based on the rosters dated January 18, 2024 and April 6, 2026, five of six residents were residing at the facility at the time when the complaint was reported. All five residents denied witnessing named incident. Six of six residents indicated that staff treat them with respect and dignity while one out of the six residents stated that a few caregivers are mean, moody, and less engaged. Three of three staff denied the allegation indicating that the residents are treated like family. Based on LPA's observation on January 18, 2024 and on today's date, staff were observed treating residents respectfully and with a smile.

Regarding the allegation, Staff does not assist residents with toileting, it is alleged that the residents are not assisted with wiping after toileting. Based on the six memory care resident interviews, five of six residents stated that they are independent. Based on the review of the ISPs, two of the six residents require full toileting assistance; however, both residents were unable to provide clear answers to the questions asked due to their medical condition. LPA was unable to further determine if residents are being assisted with wiping after toileting. Interviews with staff revealed three of three staff denied the allegation indicating that residents needed to be wiped after toileting if toileting assistance is part of their plan of care.

Regarding the allegation, Residents' hygiene needs are not being met, it is alleged that caregivers are lax in making sure that residents wash their hands after going to the bathroom resulting in a couple residents contracting a urinary tract infection. Based on the six memory care resident interviews, one of six residents indicated requiring assistance with grooming and bathing/showering while the remaining residents indicated being independent. LPA was unable to obtain further details of their hygiene care for one resident due to their medical condition. Based on the review of the ISPs, four of six residents either require a full or stand-by assist. Because five of six residents reported being independent, LPA was unable to conclude that their hygiene needs were not being met. Three of three staff interviewed denied the allegation.

Regarding the allegation, Facility does not have adequate staffing to meet residents' needs, it is alleged that ratio of caregivers to residents is too low resulting in the lack of providing proper supervision to residents. LPA conducted a walk through of the memory care building on January 18, 2024. LPA observed staff in the common area supervising residents on January 18th and on today's date. The census in the memory care unit is 45 per the roster dated April 6, 2026 and 39 per the roster dated January 18, 2024. LPA observed six staff on duty on both dates. Based on the interviews, six of six residents and three of three staff denied the allegation. Two of three staff reported that when the facility experiences inadequate staffing for the day, the activity aide, medication technician, and/or memory care director would assist as back up.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2026

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20240112171918

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 MISSION VIEJO	FACILITY NUMBER: 306005351
	VISIT DATE: 04/06/2026

NARRATIVE

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Three of three staff reported that the residents care are/have not been affected.

Therefore, based on the observations made, interviews which were conducted, and the records that were reviewed, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the following allegations: Staff does not treat residents with dignity and respect, Staff does not assist residents with toileting, Residents' hygiene needs are not being met, and Facility does not have adequate staffing to meet residents' needs are deemed UNSUBSTANTIATED.

An exit interview was conducted with Business Office Director Joan Shattler, and a copy of this report was provided at exit

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2026

LIC9099 (FAS) - (06/04)

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