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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202874
Report Date: 07/08/2025
Date Signed: 07/08/2025 05:20:53 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
06/17/2025 and conducted by Evaluator Manuel Monter
COMPLAINT CONTROL NUMBER: 26-AS-20250617095450
FACILITY NAME:IVY PARK AT SAN TOMASFACILITY NUMBER:
435202874
ADMINISTRATOR:PADILLA SANCHEZ, KENIAFACILITY TYPE:
740
ADDRESS:3930 WILLIAMS RDTELEPHONE:
(669) 201-2015
CITY:SAN JOSESTATE: CAZIP CODE:
95117
CAPACITY:82CENSUS: 24DATE:
07/08/2025
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Regional Operations Specialist Krystal JenkinsTIME COMPLETED:
05:25 PM
ALLEGATION(S):
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9
Facility Staff did not complete their required training
Hazardous items are accessible to residents in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Monter conducted an unannounced complaint inspection to deliver the findings on the above allegation. LPA met with Regional Operations Specialist Krystal Jenkins.

On June 17, 2025, the Department received a complaint alleging Facility Staff did not complete their required training.

On June 23, 2025, LPA Manuel Monter interviewed Staff S1-S4. All staff members interviewed stated they have received their required 40 hours of initial training.

Page 1 Out of 3
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2025
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 5
Control Number 26-AS-20250617095450
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 TOMAS
FACILITY NUMBER: 435202874
VISIT DATE: 07/08/2025
NARRATIVE
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On July 8, 2025, LPA Manuel Monter interviewed Staff S5-S6. Both staff interviewed stated they have completed their 40 hours of initial training.

LPA interviewed Health Services Director (HSD). HSD stated the facility staff are provided their required training.

The Department randomly reviewed 6 staff members training records. All training records reviewed are complete. No discrepancies noted.

The Department has completed the investigation of the above allegations. Based on interviews conducted and records review, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis.

Hazardous items are accessible to residents in care.

On June 17, 2025, the Department received a complaint alleging Hazardous items are accessible to residents in care.

On June 23, 2025, LPA Monter interviewed staff S1-S4. All staff interviewed stated they have not seen any detergents, bleaches or other potentially harmful materials accessible to residents in care.

LPA interviewed Regional Operations Specialist (ROS), Jessica Pryor. ROS stated the facility doesn’t have toxics/detergents or other dangerous items accessible to residents in care.

Licensing Program Analyst Manuel Monter toured the facility during the complaint investigation. LPA toured the following areas: dining area, activity area and hallways. LPA toured all residents’ bedrooms that were currently in use. This included the following bedrooms: 229, 233, 237, 238, 214, 220, 222, 226, 228, 225, 218, 217, 215, 213, 203, 201, 202, 234, 232. LPA did not observe any toxics, detergents or other potentially harmful materials accessible to residents in care.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 26-AS-20250617095450
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 TOMAS
FACILITY NUMBER: 435202874
VISIT DATE: 07/08/2025
NARRATIVE
1
2
3
4
5
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12
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On July 8, 2025, LPA Manuel Monter interviewed Staff S5-S6. Both staff interviewed stated they have not observed dangerous or toxic items accessible to residents in care.

LPA interviewed Health Services Director (HSD). HSD stated the facility staff ensure toxic materials

LPA's interviewed residents R1-R7. Residents R1-R6 stated they have not observed any toxic materials, detergents, or bleach accessible to residents in care. Resident R7 was unable to provide response to questions LPA's posed.

Licensing Program Analyst Manuel Monter toured the facility during the complaint investigation. LPA Monter and Tarin toured the facility common areas and resident bedrooms. LPAs did not observe any toxic materials, detergents or bleach accessible to residents in care.

The Department has completed the investigation of the above allegations. Based on interviews conducted and records review, the department has found that the above allegations were UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
06/17/2025 and conducted by Evaluator Manuel Monter
COMPLAINT CONTROL NUMBER: 26-AS-20250617095450

FACILITY NAME:IVY PARK AT SAN TOMASFACILITY NUMBER:
435202874
ADMINISTRATOR:PADILLA SANCHEZ, KENIAFACILITY TYPE:
740
ADDRESS:3930 WILLIAMS RDTELEPHONE:
(669) 201-2015
CITY:SAN JOSESTATE: CAZIP CODE:
95117
CAPACITY:82CENSUS: 24DATE:
07/08/2025
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Regional Operations Specialist Krystal JenkinsTIME COMPLETED:
05:25 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not assist resident under hospice with feeding.
INVESTIGATION FINDINGS:
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13
On June 17, 2025, the Department received a complaint alleging Staff did not assist resident under hospice with feeding.

On June 23, 2025, LPA Manuel Monter interviewed staff S1-S4. Staff S1, S2 and S4 stated the facility currently has 3 residents under hospice. All staff interviewed stated if residents need help with eating, then staff will assist, including residents under hospice. All staff interviewed stated staff do not forget to feed/assist residents with feeding.

LPA interviewed Regional Operations Specialist (ROS), Jessica Pryor. ROS stated the facility has a census of 26 residents. ROS stated the facility has 3 residents under hospice. ROS stated the facility staff knows which residents, such as the hospice residents, need assistance with eating. ROS stated staff is assisting residents who need help with eating.
Page 1 Out of 2.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 26-AS-20250617095450
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 TOMAS
FACILITY NUMBER: 435202874
VISIT DATE: 07/08/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
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On July 8, 2025, LPA Manuel Monter interviewed Staff S5-S6. Both staff interviewed stated they know when a resident needs assistance with eating. Both staff interviewed stated staff will assist residents with eating. Both staff interviewed stated they have not observed facility staff not assist a resident who needed assistance with eating.

LPA interviewed Health Services Director (HSD). HSD staff know to assist residents who need assistance with feeding. HSD stated staff will assist residents who haven't eaten their food and help guide them with eating. HSD stated facility staff do not neglect residents who need assistance with feeding.

LPA's interviewed residents R1-R7. Residents R1-R6 stated they do not need assistance with eating and have no issues. R1-R6 stated staff will provide assistance if they ask. Resident R7 was unable to provide response to questions LPA's posed.

Based on investigation, records reviewed, and interviews conducted, the Department found that the above allegations are UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegations did or did not occur.

Page 2 Out of 2.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5