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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006222
Report Date: 04/08/2025
Date Signed: 04/08/2025 02:43:53 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/31/2025 and conducted by Evaluator Claudia Gutierrez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250131085015
FACILITY NAME:IVY AT WELLINGTON, THEFACILITY NUMBER:
306006222
ADMINISTRATOR:VADNAIS, GERRYFACILITY TYPE:
740
ADDRESS:24903 MOULTON PARKWAYTELEPHONE:
(949) 458-2311
CITY:LAGUNA HILLSSTATE: CAZIP CODE:
92653
CAPACITY:305CENSUS: 127DATE:
04/08/2025
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Gerry VadnaisTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility did not release resident records to responsible party
INVESTIGATION FINDINGS:
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An unannounced Complaint Investigation was conducted on this day by Licensing Program Analyst (LPA) Claudia Gutierrez regarding the allegation mentioned above for the purpose of delivering findings. LPA met with Executive Director (ED) Gerry Vadnais and explained the purpose of the inspection.

It is alleged facility did not release Resident 1’s (R1’s) records to responsible party. During initial complaint investigation conducted on February 26, 2025, LPA conducted a record review of R1’s file and observed all documentation in question to be present, including physician orders and resident progress notes. During today’s visit, LPA interviewed two of two staff responsible for the release of resident records to their responsible party. During their interview, Staff 1 (S1) stated that that they had not personally received any request for release of any residents’ records, including R1. Per S1, in order for any resident’s responsible party to obtain records all that is required is a verbal request. S1 denied personally denying or having any knowledge of any staff denying resident records to their responsible party. (Cont. LIC9099-C)
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025
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 2
Control Number 22-AS-20250131085015
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: IVY AT WELLINGTON, THE
FACILITY NUMBER: 306006222
VISIT DATE: 04/08/2025
NARRATIVE
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During their interview, Staff 2 (S2) stated that in order for any resident’s responsible party to obtain records all that is required is a verbal request. S2 denied personally denying or having any knowledge of any staff denying resident records to their responsible party. S2 stated they were unsure of the exact dates, but stated R1’s responsible party had requested to review R1’s records on multiple occasion and was never denied access. S2 denied withholding any records from R1’s responsible party, including, physician orders and resident progress notes.

After record review of R1's file and due to conflicting information received during interviews conducted, LPA is unable to determine if facility did not release resident records to responsible party. Although the above allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore at this time the above allegation is unsubstantiated.

An exit interview was conducted and copy of this report was provided at the end of the inspection.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Claudia Gutierrez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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