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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 365530195
Report Date: 03/11/2025
Date Signed: 03/11/2025 02:24:44 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/06/2025 and conducted by Evaluator Javier Prieto
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250306142349
FACILITY NAME:IVY PARK AT ALTA LOMAFACILITY NUMBER:
365530195
ADMINISTRATOR:SANCHEZ, JENNIFERFACILITY TYPE:
740
ADDRESS:9519 BASELINE ROADTELEPHONE:
(909) 941-3001
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91730
CAPACITY:77CENSUS: 52DATE:
03/11/2025
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Jennifer Sanchez, Executive DirectorTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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9
Staff do not ensure that staff follow hand hygiene protocol
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javier Prieto arrived at the facility to investigate the above-mentioned complaint. LPA Prieto met with Executive Director Sanchez and explained the details of the complaint.

Allegation #1 - LPA Prieto interviewed facility nurse (S1) regarding the staff hand hygiene protocol. S1 described the facility's hand hygiene measures, stating that hand sanitizing stations are located throughout the facility. S1 added that staff are required to wear gloves when dispensing medication, addressing resident care needs, bathing, and changing residents' incontinence needs. Hand sanitizing gels are used throughout the day while working at the facility.

Executive Director Sanchez confirmed the hygiene protocols followed by the staff and added that the facility adheres to procedures outlined in the Mitigation Plan to prevent the spread of COVID-19 and other infectious diseases. LPA Prieto toured the facility as part of a Health and Safety inspection and found no immediate health or safety concerns.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025
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 56-AS-20250306142349
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: IVY PARK AT ALTA LOMA
FACILITY NUMBER: 365530195
VISIT DATE: 03/11/2025
NARRATIVE
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Based on the information obtained, there is insufficient evidence to support the allegation that staff do not follow hand hygiene protocols. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

This report was signed by LPA Prieto and Executive Director Sanchez, and a copy was left with the facility.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2