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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006222
Report Date: 03/24/2026
Date Signed: 03/24/2026 11:07:36 AM

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
11/20/2023 and conducted by Evaluator Jessica Cho
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20231120131411
FACILITY NAME:IVY AT WELLINGTON, THEFACILITY NUMBER:
306006222
ADMINISTRATOR:OLSON, KATHLEENFACILITY TYPE:
740
ADDRESS:24903 MOULTON PARKWAYTELEPHONE:
(949) 458-2311
CITY:ALISO VIEJOSTATE: CAZIP CODE:
92653
CAPACITY:160CENSUS: 220DATE:
03/24/2026
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Melanie Sigar- Assistant Executive DirectorTIME COMPLETED:
11:20 AM
ALLEGATION(S):
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Facility failed to meet resident's needs.
INVESTIGATION FINDINGS:
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On March 24, 2026, Licensing Program Analyst (LPA) Jessica Cho made an unnanounced visit for the purpose of continuing the investigation into the above allegation. LPA met with Assistant Executive Director (AED) Melanie Sigar and explained the reason for the visit. On November 20, 2023, the Department received the complaint initiated by LPA Jenifer Tirre on November 29, 2023. During the course of the investigation conducted by LPA Cho, LPA interviewed one staff/ witness and obtained copies of the following documentation for review: Resident/Staff Rosters, Residency Agreement, facility map, and written correspondence.

It is alleged that Facility failed to meet the resident's needs concerning Resident #1 (R1). Based on record review, R1 resided in the Independent Living (IL) per the Residency and Service Agreement dated April 19, 2022. Page 7 of the agreement notes under section 9. "Not a Continuing Care or RCFE Contract," the agreement does not entitle resident to receive services in the Residential Care for the Elderly component of the community.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2026
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 2
Control Number 22-AS-20231120131411
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: 03/24/2026
NARRATIVE
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LPA verified per the facility map that R1 lived on the IL side of the facility in room 259 of Building A. Interviewed staff and witness also corroborated R1 resided in the IL portion of the facility. Building A are independent and not under the purview of the Department's requirements. The license only applies to Building B, the Assisted Living.

Therefore, this agency has investigated the complaint and based on the interviews which were conducted and the records that were reviewed, the following allegation: Facility failed to meet resident's needs is deemed UNFOUNDED. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

An exit interview was conducted with Assistant Executive Director Melanie Sigar, and a copy of this report including the LIC811 were provided at exit.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2