306006203-1-29-2024-22-AS-SSAS-D2PRQV-20240222121411

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006203
Report Date: 01/29/2024
Date Signed: 01/29/2024 04:30:04 PM

Unfounded

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
01/26/2024 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20240126081206

FACILITY NAME:	IVY PARK AT SAN JUAN CAPISTRANO		FACILITY NUMBER:	306006203
ADMINISTRATOR:	PATRICIA RAGER		FACILITY TYPE:	740
ADDRESS:	32200 DEL OBISPO STREET		TELEPHONE:	(949) 496-8802
CITY:	SAN JUAN CAPISTRANO	STATE: CA	ZIP CODE:	92675
CAPACITY:	120	CENSUS:	DATE:	01/29/2024
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Peggy, Business Office Director		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Facility did not issue a full refund

INVESTIGATION FINDINGS:

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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of conducting the initial investigation into the allegation listed above. LPA was greeted and granted entry by the facility's Business Office Director Peggy (...) after introducing himself, stating the purpose of the visit and listing the allegation investigated.

Facility staff provided LPA with a copy from the signed Community fee receipt signed by resident R1 and the Regional Sales Specialist for Ivy Park, in addition to a final account statement dated December 19, 2023 and copies of a check from R1 signed on December 15, 2023 and a refund check by the facility Executive Director on December 22, 2023. Both the agreement and the ledger indicate that no charges were assessed to R1 and the amount on both checks are observed to match strictly.

CONTINUED ON FORM LIC9099-C

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2024

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-20240126081206

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 SAN JUAN CAPISTRANO	FACILITY NUMBER: 306006203
	VISIT DATE: 01/29/2024

NARRATIVE

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CONTINUED FROM FORM LIC9099
Regarding the allegation that Facility did not issue a full refund, the following has been concluded: On December 15, 2023, R1 signed a community fee receipt acknowledging that she was intending to move into the facility starting December 22, 2023 after issuing a payment in the amount of $3995 for the facility's community fee. As stated on the document and in accordance with Title 22 regulations, "If you decide not to move-in prior to the completion of the assessment 100% of the community fee will be refunded to you. If an assessment has been conducted, there is a $500 fee per person for the assessment an the remaining community fee will be refunded to you." When the prospective resident informed the facility of their intent to not move in, no assessment had been conducted yet.

Correspondingly, the final account statement for R1 shows an initial deposit in the amount of $3995 and a determination showing the amount as refundable in full. A deposit handed to the resident on December 22, 2023 was determined to also be in that amount per a copy of the check handed to R1 in person. The lease on a unit at the facility was considered to be cancelled per the facility's ledge as of December 19, 2023.

As a result, the allegation is determined to be Unfounded, meaning that meaning that the allegation is false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted and a copy of this report was provided to a facility representative.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 01/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2024

LIC9099 (FAS) - (06/04)

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