306006233-4-28-2025-22-AS-SSAS-DG82RU-20250429173807

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006233
Report Date: 04/28/2025
Date Signed: 04/28/2025 04:13:31 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
12/30/2024 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20241230100233

FACILITY NAME:	IVY PARK OF WELLINGTON		FACILITY NUMBER:	306006233
ADMINISTRATOR:	DAVID ARMOUR		FACILITY TYPE:	740
ADDRESS:	24962 CALLE ARAGON		TELEPHONE:	(562) 865-9500
CITY:	LAGUNA WOODS	STATE: CA	ZIP CODE:	92637
CAPACITY:	220	CENSUS: 171	DATE:	04/28/2025
		UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	David Armour, Administrator		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Facility is not following their Infection Control Plan

Facility did not provide the necessary cleaning services

Facility did not provide adequate medical care

INVESTIGATION FINDINGS:

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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility to follow-up on the investigation of the three allegations listed above. LPA was greeted and granted entry by front desk staff after stating the purpose of the visit. Administrator David Armour was notified and assisted with the visit in person.

The initial complaint investigation visit was conducted by licensing staff on January 8, 2025. During the visit, LPAs accompanied by facility staff toured the premises. Records maintained at the facility for six residents were requested and obtained. Three staff interviews were conducted along with one resident interview. The facility's Infection Control Plan was also requested and reviewed.
A follow-up visit took place on March 17, 2025. LPA conducted six additional staff interviews and toured the facility's memory care unit accompanied by facility staff. Additional witness interviews with Orange County Public Health staff were conducted via telephone and email during the investigation.
CONTINUED ON FORM LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2025

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-20241230100233

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 OF WELLINGTON	FACILITY NUMBER: 306006233
	VISIT DATE: 04/28/2025

NARRATIVE

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CONTINUED FROM FORM LIC9099
During the present follow-up visit, LPA requested and obtained the facility's current resident census and requested records for six current memory care residents including their identification form, individual needs and services plan as well as charting notes. LPA reviewed the documentation added to the investigation file during the visit.

Regarding the allegation that Facility is not following their Infection Control Plan, the following has been concluded: LPA was able to review the Infection Control Plan and related procedures in place during the initial complaint investigation visit. Staff interviews additionally detailed the specific measures utilized during a recent outbreak of upper respiratory infections that occurred in the facility's memory care in December 2024. Measures were listed as provision of Personal Protective Equipment for staff and residents, temporary isolation with meals provided in unit and regular checks by staff, surface cleaning in addition to weekly deep cleaning of bedrooms, emphasis on hand hygiene. Witness interviews with Orange County Public Health staff evidenced that the outbreak had been adequately reported on December 26, 2024. No concerns regarding the preventative measures implemented were stated during these interviews. Multiple staff interviews also indicated that appropriate antiviral treatment had been provided.

Regarding the allegation that Facility did not provide the necessary cleaning services, the following has been concluded: Reported concerns appeared to indicate insufficient frequency of cleanings due to staff disruption during an outbreak occurring in December 2024. None of the staff members interviewed during the course of the investigation made statements corroborating that the facility was temporarily short-staffed. Multiple interviewees described a complimentary organization from caregiving and housekeeping staff in order to address both the recurring scheduled cleaning and spot clean-ups. Each visit conducted included a tour of the physical plant during which no evidence of insufficient cleaning was observed by licensing staff. Records reviewed however demonstrated that staff failed to document whether cleaning services had been provided for the second half of December 2024.

CONTINUED ON FORM LIC9099-C

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2025

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20241230100233

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 OF WELLINGTON	FACILITY NUMBER: 306006233
	VISIT DATE: 04/28/2025

NARRATIVE

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CONTINUED FROM FORM LIC9099-C
Regarding the allegation that Facility did not provide adequate medical care, a review of resident records as well as facility self-reporting documents demonstrated that resident R1 was hospitalized on December 24, 2024 and diagnosed with Influeza A after which a course of antiviral medication was provided. No failure to provide medical care as needed during the period leading up to the present investigation could be found. Earlier health concerns were addressed appropriately as demonstrated by earlier discharge documents dated May 2024. Additional records reviewed including charting notes for a random selection of six residents showed adequate flagging of health needs and appropriate responses being provided in a timely manner.

As a result, the three allegations listed above are found to be Unsubstantiated, meaning that although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

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

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2025

LIC9099 (FAS) - (06/04)

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