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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604455
Report Date: 02/20/2025
Date Signed: 02/20/2025 01:21:35 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/12/2025 and conducted by Evaluator Ramon Serrano
COMPLAINT CONTROL NUMBER: 08-AS-20250212120748
FACILITY NAME:IVY PARK AT OTAY RANCHFACILITY NUMBER:
374604455
ADMINISTRATOR:CALAIS ANGUIANOFACILITY TYPE:
740
ADDRESS:1290 SANTA ROSE DRIVETELEPHONE:
(619) 779-7400
CITY:CHULA VISTASTATE: CAZIP CODE:
91913
CAPACITY:137CENSUS: 113DATE:
02/20/2025
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Calais AnguianoTIME COMPLETED:
01:39 PM
ALLEGATION(S):
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Resident sustained an injury due to lack of supervision
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced visit at the facility to open a complaint investigation regarding the above mentioned allegation. LPA identified themselves, stated the purpose of the visit and was greeted by Executive Director (ED) Calais Anguiano.

It was alleged that Resident 1 (R1) sustained an injury due to lack of supervision. It was reported that R1 fell down on two consecutive days, October 21st and October 22nd. On the second incident, R1 sustained a head injury and was sent to the hospital. It was further reported that Staff 1 (S1) was the responsible caregiver during both incidents.

LPA reviewed facility resident rosters dated September 2024 through February 2025. LPA also reviewed facility staff rosters dated September 2024 through February 2025. Review of records revealed R1 did not reside at the facility and S1 did not work at the above mentioned facility. LPA interviewed Outside Source (OS) who stated that R1 and S1 were located at a different facility and this complaint was generated in error.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
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 08-AS-20250212120748
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: IVY PARK AT OTAY RANCH
FACILITY NUMBER: 374604455
VISIT DATE: 02/20/2025
NARRATIVE
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LPA interviewed ED who stated that R1 has never resided at the facility and S1 has never been employed at the facility.

LPA review of initial complaint correspondence revealed the facility name and address attached to the complaint allegation did not correspond with the above mentioned senior care facility.

Based on the Department’s investigation of the above-mentioned allegation and the evidence obtained from interviews and records review, we have found that the complaint was unfounded. An unfounded determination means that the allegation was false, could not have happened and/or is without a reasonable basis. The allegation was not pertinent to this licensed facility.

The report was discussed, and an exit interview was conducted with Calais Anguiano. A copy of this report along with Licensee/Appeal Rights (LIC9058 3/22) was provided to Calais Anguiano at the conclusion of the visit. The signature below confirms the receipt of these documents.
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2