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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006766
Report Date: 05/22/2026
Date Signed: 05/22/2026 11:07:49 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
05/15/2026 and conducted by Evaluator Kimberly Lyman
COMPLAINT CONTROL NUMBER: 22-AS-20260515133019
FACILITY NAME:IVY TERRACE AT GARDEN GROVEFACILITY NUMBER:
306006766
ADMINISTRATOR:LENA GUTIERREZFACILITY TYPE:
740
ADDRESS:11848 VALLEY VIEW STREETTELEPHONE:
(714) 895-9898
CITY:GARDEN GROVESTATE: CAZIP CODE:
92845
CAPACITY:72CENSUS: 50DATE:
05/22/2026
UNANNOUNCEDTIME BEGAN:
08:10 AM
MET WITH:Lena GutierrezTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Staff do not ensure medication is administered in a timely manner
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate an investigation into the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit.
During the course of the investigation, LPA toured the facility and interviewed staff as well as reviewed and obtained pertinent documentation such as medication administration records. Regarding the allegation that staff do not ensure medication is administered in a timely manner, the investigation revealed the following: LPA reviewed resident medication administration records (MAR) for six residents. Per MAR, residents are receiving their medications as directed. Two out of two med techs confirm residents are receiving their medications as directed. During the visit, LPA toured the facility and observed five caregivers and one med tech working. Six out of six staff state working short at times due to call outs. Fully staffed is six caregivers and two med techs. All six staff interviewed confirm resident needs are being met at the facility.
CONTINUED ON LIC 9099C DATED 05/22/2026
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 22-AS-20260515133019
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: IVY TERRACE AT GARDEN GROVE
FACILITY NUMBER: 306006766
VISIT DATE: 05/22/2026
NARRATIVE
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Based on interviews conducted and record review, LPA is unable to corroborate the allegation. Therefore, the allegations are deemed unsubstantiated, meaning that although the allegations 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 facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2