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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202744
Report Date: 08/26/2026
Date Signed: 08/26/2026 04:51:38 PM

Document Has Been Signed on 08/26/2026 04:51 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:IVY PARK AT MILPITASFACILITY NUMBER:
435202744
ADMINISTRATOR/
DIRECTOR:		MEGHIAN GEULFACILITY TYPE:
740
ADDRESS:80 CEDAR WAYTELEPHONE:
(408) 770-9575
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY: 225CENSUS: 215DATE:
08/26/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Administrator Meghian GeulTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
NARRATIVE
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On August 26, 2026, Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced case management - incident visit regarding an incident report regarding resident R1. LPA met with Administrator Meghian Geul and explained the purpose of the visit.

On August 7, 2026, facility Administrator (ADM) Meghian Guel contacted the Department to report an incident regarding resident R1. ADM stated there was an elopement that occurred in the memory care unit (MCU) on August 6, 2026, at around 3:00pm. ADM stated when they discovered that R1 had eloped from the facility, they contacted local law enforcement for assistance. ADM stated resident R1 had was found a little before 4:00pm at the great mall by local law enforcement. ADM stated R1 was fine. No injuries noted.

On August 12, 2026, Licensing Program Analyst Manuel Monter interviewed staff S2-S7. S2 stated on August 6, 2026, he/she saw R1 last in the common area/activity area at 2:45pm, after being given a snack. S2 stated 15 minutes later, he/she was informed by staff that they couldn’t find R1. S2 stated during their checks, he/she noticed the delayed egress door (with the service elevator inside-across from room 125), on the left side was closed, and working. S2 stated when he/she opened that door, he/she noticed that the door beyond that was opened. S2 stated he/she inspected the area but did not observe R1. S2 stated while they were still searching for R1, he/she was notified by the Health Services Director (HSD) that R1 was found by the police, by Dave and Busters parking lot at the mall. Based on a search on google maps, the location between Ivy Park Milpitas and the Great Mall is approximately 0.8 miles.

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Romeo Manzano
Manuel Monter
DATE: 08/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 08/26/2026 04:51 PM - It Cannot Be Edited


Created By: Manuel Monter On 08/26/2026 at 01:20 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: IVY PARK AT MILPITAS
FACILITY NUMBER: 435202744

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/26/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/27/2026
Section Cited
CCR
87468.2(a)(4)

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87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a)(4) To care, supervision, and services …to meet their needs.
This requirement was not met as evidence by:
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ADM stated R1 has a 1 on 1 care giver and now has a wander guard as well. ADM stated the facility conducted Elopement training for all shifts. ADM stated she will send LPA a copy of recent training. ADM stated she will submit plan on how she will ensure an elopement doesn't occur again .
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Based on interviews and records reviewed, on August 06, 2026, resident R1 with a neurocognitive disorder eloped from memory care unit unassisted and was found by law enforcement 0.8 miles away from the facility.
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This poses an immediate Health, Safety, or Personal Rights risk to persons 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.
Romeo Manzano
NAME OF LICENSING PROGRAM MANAGER:
Manuel Monter
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/26/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/26/2026


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: IVY PARK AT MILPITAS
FACILITY NUMBER: 435202744
VISIT DATE: 08/26/2026
NARRATIVE
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S3 stated he/she was on the left side (corridor with rooms 125-135) of the memory care unit collecting laundry baskets to do laundry. S3 stated he/she was then informed by the medtech that R1 was missing and he/she assisted in searching for R1.

S6 stated he/she was the staff member who noticed that R1 was missing. S6 stated when he/she started his/her shift, he/she did a head count and confirmed everyone was in the memory care unit. S6 stated he/she did notice R1 was wandering. S6 stated around 2:45pm he/she was serving snacks to the residents. S6 stated sometime around 2:50pm-3:00pm, he/she heard the delayed egress alarm on the right side of the memory care unit (end of hallway- across from 102). S6 stated he/she responded to the delayed egress in less than 30 seconds. S6 stated he/she checked the area but did not see any resident. S6 stated he/she then did a head count once again, and couldn’t find R1. S6 stated he/she then informed the Medtech and the memory care director was notified.

S7 stated after the group meeting (which was approximately 20 minutes between about 2:30 PM and 3:00 PM) in common area regarding the activity monitor (IN2L program). S7 stated he/she then heard a door alarm activate (right side of the memory care unit end of hallway across from 102) and subsequently heard someone turn the alarm off. S7 stated he/she did not think anything of the alarm being activated and silenced. Approximately five minutes later, staff realized R1 could not be located. S7 stated staff then searched all areas of the facility and, when unable to locate R1.

2 Out of 6 staff (S4, S5) stated they were not working the day R1 eloped from the facility. 2 Out of 6 staff (S2, S3) stated the day of the elopement, they didn’t hear the delayed egress alarm. 4 Out of 6 staff (S2, S4, S5, S7) stated when R1 moved in, he/she was exhibiting wandering / exit seeking behaviors.

On August 12, 2026, Licensing Program Analyst Manuel Monter interviewed resident R1. LPA attempted to interview resident R1, but R1 would ramble about unrelated topics and would mumble when responding. LPA made multiple attempts to ask R1 questions, but R1 did not provide any relevant information regarding the day he eloped from the facility.

On August 17, 2026, Licensing program Analyst Manuel Monter interviewed staff S1 and S8. S1 stated the day of the elopement, he/she was changing another resident at the time. S1 stated as he/she was changing this resident he/she heard the delayed egress alarm. Page 2 Out of 3.
NAME OF LICENSING PROGRAM MANAGER: Romeo Manzano
NAME OF LICENSING PROGRAM ANALYST: Manuel Monter
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2026
LIC809 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: IVY PARK AT MILPITAS
FACILITY NUMBER: 435202744
VISIT DATE: 08/26/2026
NARRATIVE
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 S1 stated as he/she was finishing up, a staff member entered the bedroom he/she was in and was informed that R1 was not found and had possibly eloped. S1 stated when he/she started his/her shift, he/she observed R1 moving around the memory care unit and going place to place trying to exit.

S8 stated at the time he/she was passing out medications to residents. S8 stated sometime later that day, he/she was informed by staff S6, that R1 couldn’t be found around 2:45pm-2:50pm. S8 stated he/she did not hear the delayed egress alarm ring. S8 stated the the day of the elopement was the first time he/she met R1. S8 stated when he/she was introduced to R1, he/she did notice that R1 was being erratic and was constantly exit seeking.

The Department reviewed R1’s Progress notes.
  • Progress note dated August 5, 2026- R1 was wandering around the community trying to find an exit.
  • Progress note dated August 6, 2026 states, (am) R1 still acclimating to community. R1 spend most of the shift wandering throughout the Memory Care, while attempting to find an exit. R1 was difficult to redirect and requires close monitoring due to fall and elopement risk.
  • R1 received snack around 2:45pm from care giver. R1 continued ambulating with walker around the community. At 3:00pm care giver could not find R1. Elopement protocol initiated. Police informed. R1 was found at the great mall.

The Department reviewed R1’s Service Plan dated August 7, 2026. The Service Plan states R1 has severe impairment and demonstrates poor judgement and is potentially disruptive and dangerous to self and others.

The Department reviewed R1’s Physician’s Report, dated August 2, 2026. The physician report states R1 has a neurocognitive disorder and cannot leave the facility unassisted. R1 also lacks hazard awareness.

As a result, the Department issued an immediate civil penalty of $500 for absence of supervision, which resulted in R1 eloping from the facility.

Deficiency cited from California Code of Regulations, Title 22 during today’s visit, see LIC 809-D.

This report was reviewed with Administrator Administrator Meghian Geul and a copy of the report was provided. Appeal Rights was provided. Page 3 Out of 3. End of Report.
NAME OF LICENSING PROGRAM MANAGER: Romeo Manzano
NAME OF LICENSING PROGRAM ANALYST: Manuel Monter
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2026
LIC809 (FAS) - (06/04)
Page: 5 of 5