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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 277209411
Report Date: 08/21/2025
Date Signed: 08/22/2025 03:21:28 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/11/2025 and conducted by Evaluator Vadim Gorban
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20250811234827
FACILITY NAME:IVY PARK OF MONTEREYFACILITY NUMBER:
277209411
ADMINISTRATOR:ANDREA RAMIREZFACILITY TYPE:
740
ADDRESS:1110 CASS STREETTELEPHONE:
(818) 643-2400
CITY:MONTEREYSTATE: CAZIP CODE:
93940
CAPACITY:112CENSUS: 105DATE:
08/21/2025
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Administrator Andrea RamirezTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff did not ensure resident's room is in good repair
INVESTIGATION FINDINGS:
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On 08/21/2025, Licensing Program Analyst (LPA) V. Gorban conducted an initial complaint inspection. LPA met with administrator Andrea Ramirez and stated the purpose of the visit. LPA delivered findings after conducted an inspection of the facility.

Based on LPA’s observations, toured of the facility, and the interviews conducted, room 108 of the facility had water damage from a leak from the upper floor. The allegation that staff do not ensure resident’s room is in good repair is Substantiated. Deficiency is cited on the attached 9099-D.

Appeal rights were provided and exit interview was conducted with administrator.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
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 2
Citations on this Visit Report are Under Appeal!

Control Number 24-AS-20250811234827
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: IVY PARK OF MONTEREY
FACILITY NUMBER: 277209411
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type B
08/25/2025
Section Cited
CCR
87303(a)
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87303 Maintenance and Operation. (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include procedures for the safety and well-being of residents, employees and visitors. This requirement was not observed as evidenced by:
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Administrator agrees to provide a test/statement results regarding wall contamination in room 108. Date to visit and report will be provided to LPA by email by 08/25/25.
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Based on observations and interviews, facility staff did not start repair till August 15th, of 2025. Water leak was observed on August 09,2025. This is poses potential health and safety 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.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2