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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803921
Report Date: 07/10/2026
Date Signed: 07/10/2026 02:50:35 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/17/2026 and conducted by Evaluator Elias Magdaleno
COMPLAINT CONTROL NUMBER: 21-AS-20260417164246
FACILITY NAME:IVY PARK AT GLEN COVEFACILITY NUMBER:
486803921
ADMINISTRATOR:MOSES, CANDICEFACILITY TYPE:
740
ADDRESS:140 GLEN COVE MARINA ROADTELEPHONE:
(707) 653-4728
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY:155CENSUS: 130DATE:
07/10/2026
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Candice Moses, AdministratorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff are not providing adequate laundry service.
Staff do not ensure that resident's room is clean.
Staff are not meeting resident's hygiene needs.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Magdaleno arrived unannounced to deliver findings regarding the above allegations and met with Administrator Candice Moses.

Staff are not providing adequate laundry service and Staff do not ensure that resident's room is clean – Reporting Party (RP) alleges that staff will leave resident (R1) in dirty clothing and will not change/launder bedsheets for up to two (2) weeks and that dirty clothing is being hung in R1’s closet without being laundered. Over the course of this investigation LPA conducted interviews, made observations, and reviewed records. Interview with management indicated that housekeeping services are provided once a week through dedicated housekeeping staff and caregiving staff will clean what is left. Interview with staff indicated that they will try to make the beds and take out the trash when not done by housekeeping services.

Continued LIC9099C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Elias Magdaleno
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2026
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 5
Control Number 21-AS-20260417164246
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: IVY PARK AT GLEN COVE
FACILITY NUMBER: 486803921
VISIT DATE: 07/10/2026
NARRATIVE
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Continued from LIC9099...

Over six (6) visits LPA observed Memory Care hallways and public areas to be clean, however, during tour of R1’s room LPA observed bed to be made over dirty clothing and used tissues. Interviews with RP indicated at least six (6) documented instances over the course of two months of R1’s bedding not being laundered, despite being soiled, and dirty clothes being reused without laundering.

Staff are not meeting resident's hygiene needs – RP alleges that facility staff are not bathing R1 regularly resulting in multiple instances of R1 going one (1) or more weeks without bathing. Interviews with staff indicated that residents will not often refuse bathing, but mood changes may cause them to refuse. Further interviews indicated that if R1 is not bathed on time they will refuse bathing for the rest of the day. Review of facility Shower Refusal form indicated that upon a resident refusing a shower, the form shall be signed by a caregiver, an LVN/medtech, and a date shower moved to, and that “shower must be moved to the next day if there is a refusal”. Review of Shower Refusals for R1 indicated approximately seventeen (17) instances of showers being refused over the course of approximately five (5) months. Further review of Shower Refusals indicated four (4) of seventeen (17) were signed off by an LVN/medtech, and zero (0) of seventeen (17) had a date moved to. Review of resident care notes indicated showers were documented, however, when compared to Shower Refusals R1 is not being documented as being showered the day following a refusal and will not be showered at least until their next scheduled shower day without further refusal forms. Further review of R1 care notes indicated R1 has gone twenty (20) or more days without being showered. Interview with RP indicated multiple instances of R1 not receiving scheduled showers despite requesting them.

Based upon evidence gathered, there is a preponderance of evidence to prove that the allegation has been SUBSTANTIATED and is valid.

Deficiencies are cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, or repeat violations within a 12-month period, may result in a civil penalty assessment. Appeal rights were provided. See LIC9099D.


Exit interview conducted with Administrator, whose signature on form confirms receipt.

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Elias Magdaleno
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 21-AS-20260417164246
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: IVY PARK AT GLEN COVE
FACILITY NUMBER: 486803921
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/10/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/10/2026
Section Cited
CCR
87468.1(a)(2)
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87468.1(a)(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.

This requirement not met by Licensee as evidence by:
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Licensee shall submit plan on ensuring resident accomodations are clean and laundered by Plan of Correction due date of 8/10/2026 by 5:00PM.
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Based upon observations and interviews, R1 was not ensured clean and comfortable accomodations which poses/posed a potential risk to the Health, Safety and Rights of residents in care.
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Type B
08/10/2026
Section Cited
CCR
87464(f)(4)
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87464(f)(4) Personal assistance and care as needed by the resident... with those activities of daily living such as dressing, eating, bathing...

This requirement not met by Licensee as evidenced by:
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Licensee shall submit proof of training regarding showering and documentation by Plan of Correction due date of 8/10/2026 by 5:00PM.
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Based upon file review and interviews, R1 was not bathed as required by care plan which poses/posed a potential risk to the Health, Safety and Rights of 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: Victoria Bertozzi
LICENSING EVALUATOR NAME: Elias Magdaleno
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2026
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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/17/2026 and conducted by Evaluator Elias Magdaleno
COMPLAINT CONTROL NUMBER: 21-AS-20260417164246

FACILITY NAME:IVY PARK AT GLEN COVEFACILITY NUMBER:
486803921
ADMINISTRATOR:MOSES, CANDICEFACILITY TYPE:
740
ADDRESS:140 GLEN COVE MARINA ROADTELEPHONE:
(707) 653-4728
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY:155CENSUS: 130DATE:
07/10/2026
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Candice Moses, AdministratorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility does not employ adequate staff to meet the needs of the residents in care.
Staff are not properly trained.
Staff are not providing resident with toiletries.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Magdaleno arrived unannounced to deliver findings regarding the above allegations and met with Administrator Candice Moses.

Facility does not employ adequate staff to meet the needs of the residents in care – Reporting Party (RP) alleges that there is insufficient staff to assist residents due to high staff turnover. During the course of this investigation LPA conducted interviews, reviewed records, and made observations. Interviews with management indicated that staffing levels were high, however, there were a few weeks that had staffing changes, and a staffing company was hired to fill the holes. Interview with RP indicated they were told the facility were short staffed on a particular day and had fallen behind on resident ADLs. Review of Invoice indicated that temporary staff were hired from 3/13/2026 – 4/10/2026 through a third-party vendor. Review of Personnel Report indicated there are approximately forty-six (46) direct care staff, not including supervisors or activities staff, who work rotating 4-2 schedules to ensure coverage.
Continued LIC9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Elias Magdaleno
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2026
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 21-AS-20260417164246
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: IVY PARK AT GLEN COVE
FACILITY NUMBER: 486803921
VISIT DATE: 07/10/2026
NARRATIVE
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Continued from LIC9099A...

Over the course of six (6) visits LPA observed staffing levels to be sufficient to provide care and supervision to residents. LPA observed staff assisting residents when required as well as hosting multiple large group activities in both Memory Care and Assisted Living.

Staff are not properly trained – RP alleges that staff who provide direct care and supervision are untrained. Spot review of staff training logs indicated that sixteen (16) of eighteen (18) staff met or exceeded Title 22 regulations regarding twenty (20) hours a year of training. Interviews with management indicated that the two (2) of fifteen (15) staff who did not have full training hours were new hires still undergoing training and were not yet providing unsupervised care. Further interviews with management indicated that staff complete regular in-service training on top of online training on requested topics or in response to something new.

Staff are not providing resident with toiletries – RP alleges resident (R1) is not being provided toiletries such as toilet paper and soap/shampoo. Interview with RP indicated they do not believe R1 is being given toiletries due to visits in Memory Care where toilet paper was out and soap/shampoo was not seen in R1’s bathroom. Interview with management indicated that basic toiletries such as soap and toilet paper are provided by the facility, however, if residents wish to use specific products those products shall be provided by family/responsible party. Further interviews with management indicated that most Memory Care rooms share a joint shower that is locked from inside to prevent residents from accessing potentially harmful personal care items and wandering into other resident rooms. Soap/shampoo and other personal care items are locked in these shower rooms and will be used when staff assist residents with bathing. LPA toured joint shower room and observed it to be clean, organized, and stocked with personal care items in separate plastic cabinets assigned to each resident.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

No deficiencies cited. Exit interview conducted with Administrator, whose signature on form confirms receipt.

SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Elias Magdaleno
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5