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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006222
Report Date: 03/10/2026
Date Signed: 03/10/2026 11:47:34 AM

Substantiated


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
01/08/2026 and conducted by Evaluator Ruth Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20260108125813
FACILITY NAME:IVY AT WELLINGTON, THEFACILITY NUMBER:
306006222
ADMINISTRATOR:VADNAIS, GERRYFACILITY TYPE:
740
ADDRESS:24903 MOULTON PARKWAY BLDG BTELEPHONE:
(949) 458-2311
CITY:LAGUNA HILLSSTATE: CAZIP CODE:
92653
CAPACITY:160CENSUS: 124DATE:
03/10/2026
UNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Gerry VadnaisTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff did not provide safet transportation to residents.
Resident sustained an injury due to staff neglect.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit to the facility to conclude investigation into the above identified complaint allegations. LPA spoke with Jerry Vadnais, Executive Director, and explained the purpose of the visit.

Findings are based upon this investigation which included tour of the facility, facility file review, resident file review and interviews conducted.

It is alleged staff did not provide safe transportation to residents and resident sustained an injury due to staff neglect, specifically to driver not securing resident walkers and walkers hitting resident (R1) on the head. Interview with staff stated that it was reported by R1 of the incident once they returned to the facility. Staff

Continued on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2026
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 5
Control Number 22-AS-20260108125813
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 AT WELLINGTON, THE
FACILITY NUMBER: 306006222
VISIT DATE: 03/10/2026
NARRATIVE
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verified the validity of the incident. Staff were informed that there were two walkers that were not secured by the driver, when driving and driver made a turn the walkers moved and hit R1 on the head on their temple. Staff stated the policy is that items need to be secure in the van prior to departure. Interview with R1 stated that they were out in the community via facility van transportation when the driver was driving at a higher speed, made a sharp turn which caused the walkers to move from where they were and hit R1 in the head on their temple.

During the course of the investigation, there was sufficient evidence to substantiate the allegations. The preponderance of evidence standard has been met; therefore, the above allegations are SUBSTANTIATED. See LIC9099-D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations.

An exit interview was conducted with Executive Director and a copy of this LIC9099 and LIC9099-D, along with a copy of the appeal rights was left at the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 22-AS-20260108125813
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 AT WELLINGTON, THE
FACILITY NUMBER: 306006222
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/10/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/17/2026
Section Cited
CCR
87464(f)(1)
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Basic Services (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidence by: Staff interviews that were conducted verified that resident had been injured while in the facility
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Executive Director will provide in-services training in on the regulation cited and provide proof to LPA by POC due date.
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van. Therefore staff neglected the resident’s care. This poses an immediate health and safety risk to persons in care.
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Type B
03/17/2026
Section Cited
CCR
87312
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Motor Vehicles Used in Transporting Residents Only drivers licensed for the type of vehicle operated shall be permitted to transport residents. The rated seating capacity of the vehicles shall not be exceeded. Any vehicle used by the facility to transport residents shall be maintained
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Executive Director will provide in-services training in on the regulation cited and provide proof to LPA by POC due date.
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in a safe operating condition. This requirement is not met as evidence by: staff interviews conducted veriied walkers in the facility van were not safely secured causing injury to residens in care. This poses an immediate health and safety risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
01/08/2026 and conducted by Evaluator Ruth Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20260108125813

FACILITY NAME:IVY AT WELLINGTON, THEFACILITY NUMBER:
306006222
ADMINISTRATOR:VADNAIS, GERRYFACILITY TYPE:
740
ADDRESS:24903 MOULTON PARKWAY BLDG BTELEPHONE:
(949) 458-2311
CITY:LAGUNA HILLSSTATE: CAZIP CODE:
92653
CAPACITY:160CENSUS: 124DATE:
03/10/2026
UNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Gerry VadnaisTIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
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7
8
9
Staff did not seek medical attention for resident in a timely manner.
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit to the facility to conclude investigation into the above identified complaint allegations. LPA spoke with Jerry Vadnais, Executive Director, and explained the purpose of the visit.

Findings are based upon this investigation which included tour of the facility, facility file review, resident file review and interviews conducted.

It is alleged that staff did not seek medical attention for resident in a timely manner. Interview with staff stated that resident (R1) while out in the community sustained an injury and when R1 returned to the community it was reported immediately and medical attention was provided. R1 refused to go to hospital

Continued on LIC9099-C
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 22-AS-20260108125813
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 AT WELLINGTON, THE
FACILITY NUMBER: 306006222
VISIT DATE: 03/10/2026
NARRATIVE
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for further evaluation. Interview with R1 stated that staff provided medical attention, but they did not want to get further evaluation because they wanted to take a nap and did not want to go to hospital at that moment. Staff insisted and R1 until the following day decided to go to hospital for further evaluation.

Therefore, the Department has determined the complaint to be unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. The Department has therefore dismissed the complaint.

An exit interview was conducted with the Executive Director and a copy of this LIC9099 report was left at facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5