306006223-3-19-2025-22-AS-AJLO-DFMT3E-20250411142209

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006223
Report Date: 03/19/2025
Date Signed: 03/19/2025 01:03:17 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
02/03/2025 and conducted by Evaluator Ruth Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20250203141522

FACILITY NAME:	IVY PARK AT LAGUNA WOODS		FACILITY NUMBER:	306006223
ADMINISTRATOR:	TURGEON, JENNIFER		FACILITY TYPE:	740
ADDRESS:	24441 CALLE SONORA		TELEPHONE:	(949) 830-8057
CITY:	LAGUNA WOODS	STATE: CA	ZIP CODE:	92637
CAPACITY:	233	CENSUS: 137	DATE:	03/19/2025
		UNANNOUNCED	TIME BEGAN:	10:25 AM
MET WITH:	Jessica Hernandez		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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-Staff left resident in soiled diapers/linin for an extra period of time
-Staff will not provide resident with water
-Staff are not taking universal precautions to prevent spread of illness

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ruth Martinez visited the facility to deliver findings for the investigation into the above identified complaint allegation. LPA arrive at facility was greeted and granted entry. LPA spoke with Jessica Hernandez, Business Office Manager and explained the purpose of the visit.

Findings are based upon this investigation which included resident file review, facility file review, tour of the physical plant of the facility and interviews conducted.
It is alleged staff left resident in soiled diapers/linin for an extended period of time. Record review for resident (R1) individualized service plan and assessment do not reflect R1 has any bladder and/or bladder impairment that would require R1 to use diapers. Charting notes reflect that R1 has private caregivers and on February 3, 2025, when doing resident check in R1 was found being assisted by R1’s private caregiver in

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025

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-20250203141522

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 LAGUNA WOODS	FACILITY NUMBER: 306006223
	VISIT DATE: 03/19/2025

NARRATIVE

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the shower due to R1 not feeling well and soiling clothes. Interview with staff stated that when they checked in on R1 and found soiled clothing on the floor and R1 in shower assisted by private caregiver, staff immediately called 911 to have R1 evaluated and R1 was taken to hospital for further evaluation due to not feeling well. R1 stated that they had been sick and got the care and treatment by both private care giver and by facility staff and R1 had no complaints.

It is alleged staff will not provide resident with water. LPA toured R1’s apartment on February 4, 2025, and on today’s date and it was observed there was ample supply of water in throughout the apartment for R1’s consumption. Water bottles were observed in the kitchen, refrigerator, bedroom, living room, night stand next to the bed and in bathroom. R1 stated that the get the water they need by both private caregiver and facility staff, they have enough water in their apartment and if they don’t, they can request more by calling the front desk.

It is alleged staff are not taking universal precaution to prevent the spread of illness. On February 3, 2025, LPA Martinez received a call from Executive Director informing LPA of various resident were ill. Executive Director called the Health Department and was advised to stop all activities and close the dining hall until it had been 48 hours free of no new residents being sick. Executive Director stated on call that facility was being sanitized continuously and doing room services for residents until dining hall is open, dining hall was only open for walk in’s if residents wanted to get water or request food to take to their apartment. LPA toured the facility on February 4, 2025, and observed that staff were cleaning, sanitizing, and disinfecting the common spaces and residents’ apartments. Record review reflected that on February 3, 2025, a notice was sent to residents informing them of residents having GI symptoms throughout the community and advising them of the temporary closure of the dining, and meals being served by room service to individual resident apartments. LPA observed contact precaution carts outside of affected residents’ apartments with a contact precaution notice on the door of the apartment with precaution measures to take for entering the apartment such as wearing gloves, gowns, sanitizing and touching precaution.

Based on the information mentioned above, the Department is unable to ascertain if the allegation occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated. An exit interview was conducted with facility representative 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: 03/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2025

LIC9099 (FAS) - (06/04)

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