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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604269
Report Date: 03/05/2026
Date Signed: 03/05/2026 08:28:55 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/22/2024 and conducted by Evaluator Melisa Rankin
COMPLAINT CONTROL NUMBER: 18-AS-20241022131032
FACILITY NAME:IVY PARK AT ESCONDIDOFACILITY NUMBER:
374604269
ADMINISTRATOR:MALASPINA, KIMBERLYFACILITY TYPE:
740
ADDRESS:930 MONTICELLO DRIVETELEPHONE:
(760) 747-4888
CITY:ESCONDIDOSTATE: CAZIP CODE:
92029
CAPACITY:0CENSUS: 0DATE:
03/05/2026
UNANNOUNCEDTIME BEGAN:
08:24 AM
MET WITH:Facility ClosedTIME COMPLETED:
08:36 AM
ALLEGATION(S):
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Medication error
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rankin issued final findings for this complaint. The facility closed on 5/1/25. The LPA delivered this report via e-mail, first class mail, and certified mail. During the initial visit on 10/30/24 from 8:36am to 10:15am, LPA Javina George interviewed Health Service Director, reviewed records, obtained and requested copies of pertinent documentation. On 3/4/26, LPA Rankin reviewed available documentation and interview notes.

On the Allegation: Medication error.
It was alleged that a resident was given the wrong medication on 10/18/2024.

Documentation and an interview with the Health Services Director confirm that Resident 1 (R1) was provided medications that were prescribed for another resident on 10/18/2024. According to the facility’s LIC 624 Incident Report provided to Community Care Licensing, once the error was identified, staff contacted emergency medical services and R1 was transported to the hospital for further evaluation. Continue on 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026
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 3
Control Number 18-AS-20241022131032
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: IVY PARK AT ESCONDIDO
FACILITY NUMBER: 374604269
VISIT DATE: 03/05/2026
NARRATIVE
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 Incident report documentation indicates that R1 remained under observation for potential side effects related to receiving the incorrect medication.

Facility documentation further reflects that the medication technician involved in the incident was removed from medication duties pending review. The facility reported that medication technicians were scheduled to receive retraining conducted by the Regional Medication Specialist on 10/20/24.

Based on the information obtained through interviews and documents, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED.

Pursuant to Title 22, California Code of Regulations, the following deficiencies are cited (refer to LIC9099-D).

Copy of report will be mailed to the last known email / mailing address for the licensee.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20241022131032
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: IVY PARK AT ESCONDIDO
FACILITY NUMBER: 374604269
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/05/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/05/2026
Section Cited
CCR
87465(a)(4)
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Incidental Medical and Dental Care 87465 (a)(4) The licensee shall assist residents with self-administered medications as needed.
This requirement is not met as evidenced by:
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Facility is closed. No POC.
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Based on record review, and interviews, the licensee failed to ensure medications for resident 1 were administered as prescribed which poses an immediate health risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3