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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006233
Report Date: 09/22/2025
Date Signed: 09/22/2025 12:56:54 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
09/02/2025 and conducted by Evaluator Ruth Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250902110950
FACILITY NAME:IVY PARK OF WELLINGTONFACILITY NUMBER:
306006233
ADMINISTRATOR:DAVID ARMOURFACILITY TYPE:
740
ADDRESS:24962 CALLE ARAGONTELEPHONE:
(562) 865-9500
CITY:LAGUNA WOODSSTATE: CAZIP CODE:
92637
CAPACITY:220CENSUS: DATE:
09/22/2025
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Brenda Myers, Interim Executive DirectorTIME COMPLETED:
12:50 PM
ALLEGATION(S):
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Staff do not respond to resident's calls for assistance in a timely manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit to the facility to conclude investigation to the above identified complaint allegation. LPA arrived at the facility and was greeted at the door and granted entry. LPA spoke with Brenda Myers, Interim Executive Director and explained the purpose of the visit.

Findings are based upon this investigation which included tour of the facility, facility file review, resident file review and interviews conducted.

It is alleged that staff do not respond to residents’ calls for assistance in a timely manner. An interview with staff stated that when a pendant is pressed that common practice on response time is 15 minutes max and staff respond on a timely manner. LPA conducted a facility visit on September 3, 2025, and
Continued on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2025
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 22-AS-20250902110950
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: IVY PARK OF WELLINGTON
FACILITY NUMBER: 306006233
VISIT DATE: 09/22/2025
NARRATIVE
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toured the resident’s (R1) apartment, upon entry LPA found R1 upset and crying in their bedroom due to pressing pendant for assistance and have not been checked on. LPA walked to the front desk of the facility and arrived at 11:00am. LPA observed on the receptionist computer that the call logs reflected R1’s pendant had been pressed at 10:29AM and had not been checked on. Record review for pendant call log reflected that for September 3, 2025, pendant call that time was pressed at 10:29am response time was 40 minutes and 40 seconds. Review of records from August 3, 2025, to September 11, 2025, pendant response time was anywhere from 1 minute 30 seconds to 95 minutes 39 seconds.

During the course of the investigation, there was sufficient evidence to substantiate the allegation. The preponderance of evidence standard has been met; therefore, the above allegation is SUBSTANTIATED. See LIC9099-D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations.

An exit interview was conducted with facility representative and a copy of this LIC9099 and LIC9099-D, along with a copy of the appeal rights was left at the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
09/02/2025 and conducted by Evaluator Ruth Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250902110950

FACILITY NAME:IVY PARK OF WELLINGTONFACILITY NUMBER:
306006233
ADMINISTRATOR:DAVID ARMOURFACILITY TYPE:
740
ADDRESS:24962 CALLE ARAGONTELEPHONE:
(562) 865-9500
CITY:LAGUNA WOODSSTATE: CAZIP CODE:
92637
CAPACITY:220CENSUS: DATE:
09/22/2025
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Brenda Myers, Interim Executive DirectorTIME COMPLETED:
12:50 PM
ALLEGATION(S):
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Staff do not ensure resident's room is clean and sanitary.
Staff are unable to communicate with residents due to a language barrier.
Staff do not provide adequate laundry service.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit to the facility to conclude investigation to the above identified complaint allegations. LPA arrived at the facility and was greeted at the door and granted entry. LPA spoke with Brenda Myers, Interim Executive Director and explained the purpose of the visit.

Findings are based upon this investigation which included tour of the facility, facility file review, resident file review and interviews conducted.
It is alleged that staff do not ensure resident’s room is clean and sanitary. Review of records revealed that admissions agreement: page 2 section 3 Ivy Park will provide you with weekly housekeeping services as part of your monthly fee. Additional housekeeping services as needed or requested will be provided for an additional charge as set forth in Appendix A. LPA conducted a tour of the facility on September 3, 2025,

Continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 22-AS-20250902110950
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: IVY PARK OF WELLINGTON
FACILITY NUMBER: 306006233
VISIT DATE: 09/22/2025
NARRATIVE
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and observed housekeeping staff cleaning resident apartments on various floors. An interview with staff stated that residents’ apartments are cleaned once a week and are on a weekly schedule. Records revealed that the facility has housekeeping schedules where residents’ apartments are listed on different dates and various of shifts. Resident interview revealed that their apartments do get cleaned as schedule, see staff clean blinds and clean that apartment thoroughly. They don’t always pick up every trinket and dust them, but apartments are cleaned and sanitized as they should once a week.

It is alleged that staff are unable to communicate with residents due to a language barrier. Interview with 7 of 7 residents stated that they are able to communicate with staff and never have had an issue with staff not being able to understand their needs. Residents stated that even though they do not speak perfect English communication is not an issue. Interview with staff stated they have never gotten any complaints that resident have had any communication difficulty with the care staff.

It is alleged that staff do not provide adequate laundry service. Interview with staff stated that laundry service for residents is scheduled once a week and residents are sent on a scheduled basis that reflect weekly. Per admissions agreement laundry service is on a weekly basis and if resident require further services it is reflected on appendix A. Per agreement facility provides basic laundry services of washing and folding clothes. Interview with 7 of 7 residents stated that their laundry is done once a week and they have never had issues with their laundry not being done. Residents stated that staff take their laundry and bring it back clean, at times care staff put away/hang their clothes and at times they forget to hang clothes. Record review revealed admissions agreement: page 2 section 2 Laundry: personal laundry assistance from the community's staff will be available. The community will provide laundry services for bed and bath linens and personal laundry on a weekly basis. Additional laundry services as needed or requested will be provided for an additional charge as set forth in Appendix A.

Based on the information mentioned above, the Department is unable to ascertain if the allegation occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegations are deemed Unsubstantiated.

An exit interview was conducted with the facility representative and a copy of this LIC9099 report was left at facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 22-AS-20250902110950
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: IVY PARK OF WELLINGTON
FACILITY NUMBER: 306006233
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/22/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/29/2025
Section Cited
CCR
87464(f)(1)
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 Basic services (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidence by: Based on record review and facility tour conducted by LPA, there were multiple
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Executive Director will assign the Health Services Director to keep track and audit pendant pushes regularly and keep documentation, conduct in-service training and identify root causes of excessive wait times.
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instances of excessive response times that were recorded. This constitutes a potential risk to the health, safety and personal rights of individuals in care.
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Written documentation of the corrections to be provided to LPA by POC due date.
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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: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5