306006463-8-20-2026-22-AS-SSAS-DY2R4V-20260918124211

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006463
Report Date: 08/20/2026
Date Signed: 08/20/2026 02:41:33 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
08/11/2026 and conducted by Evaluator Brandon Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20260811101810

FACILITY NAME:	IVY PARK AT FULLERTON		FACILITY NUMBER:	306006463
ADMINISTRATOR:	MATSUMOTO, CHRISTINA		FACILITY TYPE:	740
ADDRESS:	2226 NORTH EUCLID STREET		TELEPHONE:	(714) 738-3656
CITY:	FULLERTON	STATE: CA	ZIP CODE:	92835
CAPACITY:	85	CENSUS: 75	DATE:	08/20/2026
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Executive Director Christina Matsumoto		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff are not responding to residents call buttons in a timely manner

INVESTIGATION FINDINGS:

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On August 20, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to initiate the investigation into the allegation listed above and to deliver the complaint findings. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Executive Director Christina Matsumoto was present and assisted on today's visit.

During the visit, LPA conducted resident interviews, staff interviews, reviewed and obtained pertinent documents for this complaint. Regarding the allegation, staff are not responding to residents call buttons in a timely manner, the following has been concluded: It was alleged that staff did not respond to Resident #1 (R1) call button in a timely manner. During the investigation, LPA conducted an interview with R1. R1 corroborated the allegation and reported that staff did not respond to him in a timely manner on July 11, 2026. R1 stated that it took staff approximately thirty minutes to assist him on that day. Additionally, during the visit, LPA tested the call button for R1. LPA observed that staff responded to the call button request in less than five minutes. LPA conducted an additional seven resident interviews. CONTINUED ON LIC9099-C

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2026

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-20260811101810

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 FULLERTON	FACILITY NUMBER: 306006463
	VISIT DATE: 08/20/2026

NARRATIVE

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Three residents reported that they have not used their call buttons before, and therefore were unable to provide any information into this allegation. However, the remaining five residents denied the allegation and reported that staff have assisted them in a timely manner after using their call buttons. LPA also conducted six staff interviews. During the staff interviews, it was discovered that the facility experienced a network outage on July 11, 2026, which affected their call button system. It was reported that staff had to conduct manual room check-ins while the network system was restored but that there was sufficient staff available during this time. LPA also discovered that the facility's call button system does not keep a record of the call button activations and the time it takes for staff to respond to the request. However, one staff interviewed corroborated the allegation and reported that there have been times were staff have been unable to respond timely to a call button due to a staffing shortage on that shift. However, five out of the six staff interviewed denied the allegation and reported that staff are able to respond timely to call button request. The five staff also reported that they have not received any complaints from residents regarding their call buttons.

Based on the evidence gathered during the investigation, the Department is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, the one allegation above is deemed UNSUBSTANTIATED. An exit interview was conducted with Executive Director Christina Matsumoto and a copy of the report was provided at time of visit.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2026

LIC9099 (FAS) - (06/04)

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