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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006203
Report Date: 06/01/2023
Date Signed: 06/01/2023 01:21:58 PM

Unsubstantiated


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
05/30/2023 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230530095524
FACILITY NAME:IVY PARK AT SAN JUAN CAPISTRANOFACILITY NUMBER:
306006203
ADMINISTRATOR:MENSAH, ERICFACILITY TYPE:
740
ADDRESS:32200 DEL OBISPO STREETTELEPHONE:
(949) 496-8802
CITY:SAN JUAN CAPISTRANOSTATE: CAZIP CODE:
92675
CAPACITY:120CENSUS: 48DATE:
06/01/2023
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Tammy OjwangTIME COMPLETED:
01:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff did not safeguard residents belongings.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegation listed above. LPA met with Executive Director Tammy Ojwang and explained the reason for the visit. The investigation into the allegation revealed the following. It was alleged the facility staff did not safeguard resident's belongings and the belongings of Resident 1 (R1) were damaged. R1 could not be reached for interview. Staff reported that on 1/31/23 the Orange County Sheriff was contacted by R1 and R1 reported a theft to the Sheriff. Staff reported that the Sheriff took no action and did not provide a report number. Staff reported that R1 had not reported to staff any personal items being stolen or damaged. R1 has moved out of the facility. A review of documents shows R1 declined to have their personal property inventoried. The facility is not responsible for the personal belongings that are not put in their care to be safeguarded. None of the evidence gathered supports the allegation. Based on the evidence gathered the allegation, facility staff did not safeguard residents belongings is deemed unsubstantiated. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted and a copy of the report provided
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: (951) 473-7041
LICENSING EVALUATOR SIGNATURE:

DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023
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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