198204069-1-7-2026-11-AS-SCIS-DT5R3P-20260414124014

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204069
Report Date: 01/07/2026
Date Signed: 01/07/2026 09:20:31 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/17/2025 and conducted by Evaluator Bernadette Allen

COMPLAINT CONTROL NUMBER: 11-AS-20251117102758

FACILITY NAME:	IVY PARK AT SANTA MONICA		FACILITY NUMBER:	198204069
ADMINISTRATOR:	CLIFTON DOUYON		FACILITY TYPE:	740
ADDRESS:	1312 15TH ST		TELEPHONE:	(310) 899-1976
CITY:	SANTA MONICA	STATE: CA	ZIP CODE:	90404
CAPACITY:	100	CENSUS: 70	DATE:	01/07/2026
		UNANNOUNCED	TIME BEGAN:	08:35 AM
MET WITH:	Clifton Douyon- Administrator		TIME COMPLETED:	09:45 AM

ALLEGATION(S):

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Licensee does not ensure that residents are able to sleep at night
Licensee does not ensure facility plumbing is maintained in good repair

INVESTIGATION FINDINGS:

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***This report supersedes the original report delivered on 11/21/2025. On 1/07/2026, Licensing Program Analyst (LPA) Bernadette Allen arrived at the facility to deliver the corrected 9099, providing clarification on the original report issued on 11/21/2025. ***

On 11/21/2025, at 9:45AM, Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to conduct a complaint investigation and deliver findings for the alleged allegations. LPA identified herself and met Clifton Douyon -Administrator who was informed of the purpose of the visit.

On 11/21/2025 LPA requested and obtained a staff roster dated 8/27/2025 and resident roster dated 11/19/2025. LPA conducted interviews with staff members 1-5 (S1-S5) and Residents 1-8 (R1-R8). LPA requested copies of the following documents for Resident 1(R1) admissions agreement dated 6/30/2025, customer agreement dated 7/7/2025, physicians report dated 6/23/2025, plumbing invoice for repairs dated 10/6/2025 and 10/18/2025, and proof of credit/refund for inconvenience for R1 dated 10/16/2025.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 01/07/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20251117102758

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: IVY PARK AT SANTA MONICA	FACILITY NUMBER: 198204069
	VISIT DATE: 01/07/2026

NARRATIVE

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email correspondence between residents and/or responsible parties regarding renovations being conducted with details of changes, projected timeline, and floor order of work dated 9/23/2025,10/24/2025 and a copy of the Notice dated 9/23/2025. LPA also toured the facility and observed renovations had been done throughout the facility painted walls and new carpet/flooring.

The investigation consisted of the following:

Allegation 1: Licensee does not ensure that residents are able to sleep at night

On 11/21/2025 LPA conducted interviews with staff members 1-5 (S1-S5) and 5 out of 5 staff members stated residents and their responsible parties were informed verbally and by correspondence/email and also provided with the executive director update notice dated 9/23/2025 of the renovations being conducted with details of changes, projected timeline, and floor order of work dated 9/23/2025. Staff also acknowledged some residents did have complaints but understood, under the circumstances, and were made aware of the community cosmetic updates being done and the staff /workers made efforts to minimize disruptions during the night to ensure residents could get sleep at night.

The interviews with Resident 1-8 (R1-R8) were as follow, LPA attempted to interview R1 and they no longer reside at the facility, R2 stated that they could not remember anything and R3 was on their way to an appointment and was unwilling to talk.

Interviews with residents R4, R5, R6, R7 and R8 revealed that they did not initially recall receiving a notice about the renovations. However, when shown the Executive Director’s update dated 09/23/2025, all five (5) residents acknowledged seeing the notice posted throughout the facility. They also recalled being verbally informed on several occasions about the changes taking place.

Residents R4, R5, R6, R7and R8 reported that their sleep was occasionally interrupted due to the renovations but understood the reason for the disturbance and stated although there was some nighttime noise they were able to sleep, and staff/workers made efforts to minimize disruptions during the night.

Continued

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 01/07/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2026

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20251117102758

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: IVY PARK AT SANTA MONICA	FACILITY NUMBER: 198204069
	VISIT DATE: 01/07/2026

NARRATIVE

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Allegation 2- Licensee does not ensure facility plumbing is maintained in good repair

On 11/21/2025 LPA conducted interviews with staff members 1-5 (S1-S5) and 5 out of 5 staff members stated when plumbing issues occur in the building the plumber is called and scheduled for service. LPA also observed documentation of the plumbing service conducted on 10/6/2025 and 10/18/2025 including correspondence confirming relocation of R1 into another room along with refund/credit for inconvenience.

The interviews with Resident 1-8 (R1-R8) were as followed, LPA attempted to interview R1 who no longer reside at the facility, R2 stated that they could not remember having any plumbing problems and R3 was on their way to an appointment and unwilling to talk.

The interviews with R4, R5, R6, R7 and R8 stated that they have not had any problems with plumbing in their rooms and if they did management would be informed and expressed confidence repairs would be made immediately.

Based on interviews, documents reviewed and observation during the investigation, the above allegation is found to be Unsubstantiated; meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted where this report was discussed and provided to Clifton Douyon - Administrator at conclusion of the visit with appeal rights. Clifton was unavailable to sign the report but Solaange Nkafu was authorized to sign the report

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 01/07/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2026

LIC9099 (FAS) - (06/04)

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