306006402-5-19-2026-22-AS-LMOA-DUU672-20260607203250

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006402
Report Date: 05/19/2026
Date Signed: 05/19/2026 04:56:06 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
10/23/2025 and conducted by Evaluator Edward Kim

COMPLAINT CONTROL NUMBER: 22-AS-20251023162755

FACILITY NAME:	IVY PARK AT SEAL BEACH		FACILITY NUMBER:	306006402
ADMINISTRATOR:	TAMI OJWANG		FACILITY TYPE:	740
ADDRESS:	3850 AND 3840 LAMPSON AVE		TELEPHONE:	(562) 594-5788
CITY:	SEAL BEACH	STATE: CA	ZIP CODE:	90740
CAPACITY:	261	CENSUS: 182	DATE:	05/19/2026
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Administrator- Tami Ojwang		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff stopped residents medication without a physicians order

INVESTIGATION FINDINGS:

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On May 19, 2026, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced subsequent complaint visit to deliver findings at the facility for the above allegation. LPA Kim met with Administrator Tami Ojwang and explained the purpose of the visit.

The investigation consisted of the following: LPA Kim conducted a physical plant tour inside and outside of the facility and no concerns were observed. LPA Kim reviewed one resident record, which include: Admission Agreement, Identification and Emergency Information, Physician's Report, Needs and Services Plans/Reappraisal, charting notes, Medication Administration Record, and other pertinent records.

The investigation revealed the following:

Continued on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2026

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-20251023162755

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 SEAL BEACH	FACILITY NUMBER: 306006402
	VISIT DATE: 05/19/2026

NARRATIVE

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Allegation: Staff stopped residents medication without a physicians order.
It is alleged when a resident’s medication was in low supply that it was canceled by facility staff due to a blood test being necessary without physician approval. It is alleged that the prescription was not refilled due to this incident.

Based on record review, R1’s physician report dated October 1, 2025, diagnosed R1 with vascular dementia. R1’s Charting notes dated August 7, 2025, that R1’s family notified the facility a medication needs to be placed on hold. Staff notified R1’s family that an official hold order is needed from the doctor. Staff attempted to contact the doctor to receive the hold order. Medication Administration Record dated October 2025, stated the doctor placed the medication on hold from August 7, 2025, to October 9, 2025. Starting from October 9, 2025, the medication was administered to R1 because the medication was placed off hold. Charting Notes dated October 9, 2025, states the letter of clearance signed by the doctors was received by the facility.

Based on interviews conducted, S1 and S3 stated that R1 had only one medication placed on hold. This was done because the family stated the doctor placed the medication on hold. S1 and S3 stated once the order was received to place it on hold, the facility would have withheld the medicine from R1. Once the Physician’s Order was received for R1 to receive the medication, the facility would administer the medication.
Based on the information gathered, there is no sufficient evidence to confirm the above allegation.

Based on interviews and records review, LPA did not find sufficient evidence to support the above allegation Staff stopped residents medication without a physicians order. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

Exit interview was conducted and a copy of the report was provided to Administrator Tami Ojwang.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2026

LIC9099 (FAS) - (06/04)

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