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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202847
Report Date: 04/09/2026
Date Signed: 05/05/2026 06:02:22 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/02/2026 and conducted by Evaluator Maria Partoza
COMPLAINT CONTROL NUMBER: 26-AS-20260402150201
FACILITY NAME:IVY PARK AT SAN JOSEFACILITY NUMBER:
435202847
ADMINISTRATOR:BALDUGO, VALERIEFACILITY TYPE:
740
ADDRESS:4855 SAN FELIPE ROADTELEPHONE:
(408) 223-1312
CITY:SAN JOSESTATE: CAZIP CODE:
95135
CAPACITY:140CENSUS: DATE:
04/09/2026
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Valerie Baldugo - Assoc. Exec. DirectorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff dId not ensure that resident’s’ bed is kept in good repair.
INVESTIGATION FINDINGS:
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*** This report is being AMENDED due to additional information received. SEE PAGE 2****

LPA Maria (Mita) Partoza conducted an unannounced visit to deliver findings regarding the allegation that staff did not ensure residents’ beds were kept in good repair. LPA met with Associate Executive Director (AED) Valerie Baldugo and stated the purpose of the visit.

The Department received the complaint on 04/02/2026 and conducted the initial 10 day investigation on 04/03/2026. LPA inspected resident rooms, interviewed staff and residents and requested documennts.


page 1 of 2
see LIC 9099C
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026
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 26-AS-20260402150201
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 SAN JOSE
FACILITY NUMBER: 435202847
VISIT DATE: 04/09/2026
NARRATIVE
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On 04/03/2026 - Three resident(R1 to R3) and one staff (S1) were interviewed. S1 stated that rooms are initially unfurnished and residents generally supply their own furniture, including beds. The facility provides basic furniture only for residents without their own, and facility provided beds are repaired or replaced by maintenance when needed. S1 also stated that some Assisted Living residents use hospital beds supplied through their insurance, and those beds are serviced by the corresponding DME vendor. The facility assists residents in contacting vendors as needed.

1 Out of 3 residents declined to be interviewed, 1 Out of 3 does not have information on who supplied their bed, and 1 Out of 3 is waiting to get their hospital bed repaired from the hospital bed provider. 1 Out of 3 residents stated they are aware that CCLD does not have jurisdiction over beds not supplied by the facility.
Inspection showed that all three residents had hospital beds with vendor information on the bedframe. Facility documents indicated that hospital beds are not provided by the facility and are not included in the admission agreement. ****Additional information On 04/29/2026, LPA randomly inspected 4 memory care room (2 shared and 2 private (R4 to R7) that uses medical beds and 6 resident (R8 to R13) in assisted living. 2 out of the 6 resident in the AL uses hospital bed, which are in good working condition. LPA conducted interviews with 5 staff (S2 to S6), S2 & S6 stated that they have not seen a broken bed in the MC & AL section. S3 and S5 stated that R1 did complain about the noise that R1s medical bed was making but did not see any visible break on the frame, or bolts coming off and no oil leaking from the bed. S3 & S5 stated they reported R1s complaint about his/her bed making a noise to S4 and S4 came and checked on the bed. S4 stated if it is a loose bolt that needs tightening, maintenance will tighten the bolt, however, because of liability issue maintenance cannot repair a broken medical bed which was issued to the resident by their medical provider. S4 stated to facilitate repair of a broken medical bed or beds, the residents or caregivers calls the front desk to request for service. Maintenance will check on the problem and either repair or refer the issue to the management team. If it is a medical bed management assists resident in contacting their medical supplier to get their medical bed either replaced or repaired.

This agency has investigated the complaint alleging that staff did not ensure that resident’s’ bed is kept in good repair. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. No deficiencies were cited based on the California Code of Regulations (CCR) Title 22. An exit interview was conducted and a copy of the report was provided to AED Valerie Baldugo. End of report
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE:

DATE: 04/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026
LIC9099 (FAS) - (06/04)
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