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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006456
Report Date: 10/14/2024
Date Signed: 10/14/2024 12:36:11 PM

Document Has Been Signed on 10/14/2024 12:36 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 AT HUNTINGTON BEACHFACILITY NUMBER:
306006456
ADMINISTRATOR/
DIRECTOR:		REAMER-YU, BRYANFACILITY TYPE:
740
ADDRESS:7401 & 7351 YORKTOWN AVE.TELEPHONE:
(714) 536-3032
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92648
CAPACITY: 142CENSUS: 96DATE:
10/14/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
07:10 AM
MET WITH:Executive Director Bryan Reamer-YuTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Jenifer Tirre made an announced pre-licensing visit. LPA identified themselves and discussed the purpose of the visit with Executive Director Bryan Reamer-Yu. An initial application to operate a Residential Facility Care for the Elderly was submitted to CCL on 08/13/2024. There are 96 residents in care during today's visit. LPA observed facility is following infection control guidelines.
LPA Tirre along with Executive Director Brian Reamer-Yu toured the facility at 7:55 AM and observed the following:

Structure: Facility is a two story building housing 48 apartment units in the assisted living and 47 apartment units in the Memory care. Memory care has three neighborhood's on first and second floor of main building as well as The Cottage building directly across from main building. Facility offers four dining rooms, a bistro area, A Television room, activities room, and salon as well as outside patio areas. Living Room/ Dining Room: There is adequate seating and appropriately furnished areas for relaxation in Living room areas and adequate seating available in each dining room areas. Bedrooms Residents: All rooms toured are equipped with appropriate lighting, chair, night stand and ample closet space for resident belongings. Bathrooms: All resident bathrooms have a working toilet/ wash basin as well as grab bars and non-skid surface in the shower. Emergency Phone Numbers and Exit Plan: Posted near entrance of facility. Food Service: Facility has ample perishable and non perishable food supplies. LPA observed posted menus throughout facility with multiple choices for residents. Smoke Detectors: Carbon monoxide detectors and Smoke detectors are tested in-house and documentation was provided by Johnson Controls. Documentation shows that 263 Smoke Detectors were tested operational and passed on last inspection date 12/18/2023. LPA observed 8 Fire extinguishers which were fully charged and accompanied by emergency flashlight. Toxins: Secured and inaccessible to residents in care. Water Temperature: Tested and recorded between 105.2 and 117.5 degrees F tested in both resident and common area bathrooms. Eight restrooms were tested during inspection visit Emergency Supplies: LPA observed ample emergency food and water stored on site in facility storage.
CONTINUED ON LIC 809C
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE: DATE: 10/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/14/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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 AT HUNTINGTON BEACH
FACILITY NUMBER: 306006456
VISIT DATE: 10/14/2024
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LPA observed the emergency disaster plan and facility has submitted infection control plan as well.Medications, First-Aid Kit & Book: LPA observed first aid kit contained required elements. Medications are stored in locked medication carts. Facility has secured location for resident and personnel files Resident & Staff File: LPA reviewed 5 staff and 5 resident files during the visit. All files had completed documents. Reading Material, Games, and Equipment: LPA observed multiple activities calendars in multiple locations. Outside areas: LPA observed outside shaded areas for residents. Outside areas are easily accessible to residents in both assisted living and in memory care areas. Fire Clearance: Approved for 134 non-ambulatory residents and 8 bedridden residents on 8/12/2024. LPA observed the emergency chair adjacent to the staircase located on second floor.

Facility has liability insurance on file for 5/1/2024 to 5/1/2025. Administrator's Certificate on file for Bryan Reamer-Yu Expiring 8/25/2026.

The facility is ready to be licensed.

Component III not conducted during visit due to facility Executive Director currently operating licensed facilities for the past twelve years.

An exit interview was conducted with Executive Director and a copy of this report was left at the facility.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2024
LIC809 (FAS) - (06/04)
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