306006402-5-13-2026-22-AS-APAO-DU97AF-20260519212929

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006402
Report Date: 05/13/2026
Date Signed: 05/13/2026 03:29:33 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
08/21/2025 and conducted by Evaluator Edward Kim

COMPLAINT CONTROL NUMBER: 22-AS-20250821153955

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:	05/13/2026
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Administrator-Tami Ojwang		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff did not give resident medication as prescribed.

INVESTIGATION FINDINGS:

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On May 13, 2026, at 8:30 AM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced subsequent complaint visit 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 includes: Admission Agreement, Identification and Emergency Information, Physician's Report, Needs and Services Plans/Reappraisal, Medication Administration Records, Centrally Stored Medication Destruction Records, 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: 05/13/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2026

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-20250821153955

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: 05/13/2026

NARRATIVE

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Allegation: Staff did not give resident medication as prescribed
It is alleged that resident has been administered the wrong medication. The staff have given the wrong number of pills and the resident has gone to the medication office to get the medication. It is alleged that the facility received antibiotics but was not given it until the next day.

Based on record review, R1 was admitted to the facility on July 31, 2023. R1’s physician report dated August 25, 2025, diagnoses the resident with hypertension, type 2 diabetes, and being nonambulatory. A Resident Assessment was performed on March 21, 2025, because there was a change of condition that stated the resident need assistance with medication, assistance with showers/bathing, and meal time reminders. R1’s Charting Notes dated August 19, 2025, to August 23, 2025, stated R1 waw administered their antibiotic medication for five days. Charting notes stated the resident did not express any pain or discomfort. On an email correspondence dated August 25, 2025, W1 stated R1 was given two blood pressure pills instead of one pill. S2 explained that the two pills totaled the same dosage as the prescribed single pill. Centrally Stored Medication Destruction Record (CSMDR) dated August 18, 2025, that the inhaler and the antibiotic were received and was started on August 19, 2025 at 11:00 AM. Physician’s order stated the antibiotics were take one pill for two times a day. There is no specific time of day when it needs to be taken. CSMDR dated August 24, 2025, the blood pressure medication was filled and given on the next day.
Based on interviews conducted, S7 stated that R1 was administered their blood pressure medication on August 25, 2025. S1 and S2 stated the facility administered their antibiotic medication from August 19, 2025, to August 23, 2025, as prescribed. S2 and S7 stated the process for the medication being received is to firsts verify the medication was received then administer as soon as possible.

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 did not give resident medication as prescribed. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are 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: 05/13/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2026

LIC9099 (FAS) - (06/04)

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