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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604455
Report Date: 06/13/2025
Date Signed: 06/13/2025 03:29:33 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
05/30/2025 and conducted by Evaluator Dang Nguyen
COMPLAINT CONTROL NUMBER: 08-AS-20250530085015
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: 122DATE:
06/13/2025
UNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Health Services Director Eva Zuluaga and Senior Regional Business Office Director Specialist Aaron PhillipsTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Licensee did not issue refund as required.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced subsequent visit to deliver a finding regarding the above prior complaint allegation. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Health Services Director Eva Zuluaga and Senior Regional Business Office Director Specialist Aaron Phillips.

The Complainant alleged that Licensee did not issue refund as required to Resident #1 (R1). [See LIC 811 Confidential Names List for a description of R1.] CCLD’s investigation involved unannounced facility tours/welfare check and interview of pertinent staff and outside sources. The Department also reviewed R1’s facility admissions agreement contract, R1’s facility billing records, R1’s official death certificate from the county, incident reports from Licensee, additional financial statements, and U-Haul billing records.

[CONTINUED ON LIC 9099-C, 1 of 2]
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2025
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 08-AS-20250530085015
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: IVY PARK AT OTAY RANCH
FACILITY NUMBER: 374604455
VISIT DATE: 06/13/2025
NARRATIVE
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[CONTINUED FROM LIC 9099]

Interviews and records showed: R1 was independent in care and medications, paying Licensee only for room and board. On 03/29/2025, R1 was transported to the emergency room, where they were admitted and hospitalized. On 04/09/2025, R1’s responsible person (RP) vacated R1's apartment of belongings, relinquishing control of the room to Licensee. Licensee continued to bill R1 for room and board through 05/09/2025, which was initially consistent with the 30-day move-out notice provision in R1’s residency agreement, so long as R1 was alive. However, R1 died at the hospital on 04/25/2025, as confirmed by their official death certificate from the county. On 04/30/2025, R1’s RP notified Licensee that R1 had since died, and Licensee replied to confirmed receipt.

R1’s admissions agreement states, “Death of Resident: This Agreement shall terminate automatically upon your death.” Furthermore, California Health and Safety Code Section 1569.652 specifies in part, “(a) A residential care facility for the elderly shall not require advance notice for terminating an admission agreement upon the death of a resident. No fees shall accrue once all personal property belonging to the deceased resident is removed from the living unit.” R1’s admissions agreement also states that in cases where a resident has died, “Within fifteen (15) days after your personal property is removed from your apartment, your estate, or other person or entity responsible for payment of fees under this Agreement, will receive a refund of any fees paid in advance covering the period after your personal property has been removed.” This 15-day refund deadline is also consistent with California Health and Safety Code. As of the commencement of CCLD’s investigation on 06/02/2025, Licensee still had not credited/refunded C1’s account/estate for room and board fees from 04/26/2025 through 05/09/2025, as were owed.

Additionally, records and interviews showed: Earlier on 11/10/2024, R1 spent $114.88 on pest control products for their facility apartment, in response to seeing mice in their room. Upon discovering this expenditure, R1’s RP spoke with a facility manager, who agreed to speak with the facility administrator regarding a credit/refund of this money. This manager claimed they did speak to the administrator about this. However, the RP told CCLD they did not receive a follow-up response from Licensee, one way or the other. [CCLD’s subsequent investigation substantiated the earlier presence of mice in R1’s facility apartment, based on witness testimony and photographic evidence.] During today’s visit, Licensee agreed to additionally credit/refund this incidental amount to R1’s account/estate. [CONTINUED FROM LIC 9099-C, 2 of 2]
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 08-AS-20250530085015
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: IVY PARK AT OTAY RANCH
FACILITY NUMBER: 374604455
VISIT DATE: 06/13/2025
NARRATIVE
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[CONTINUED FROM LIC 9099-C, 1 of 2]

Based on records and interviews, a preponderance of evidence exists to show Licensee earlier did not issue refund as required to R1. The allegation was therefore Substantiated, and one (1) deficiency was cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D page). A Plan of Correction were jointly developed with the Licensee.

An exit interview was conducted with Zuluaga, to whom a copy of this report, the LIC 9099-D page, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 08-AS-20250530085015
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: IVY PARK AT OTAY RANCH
FACILITY NUMBER: 374604455
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/13/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/13/2025
Section Cited
HSC
1569.652
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1569.652 Termination of admission agreement upon death of resident; removal of resident’s property; refund of fees paid; notice of contract termination and refunds: “(a) A residential care facility for the elderly shall not require advance notice for terminating an admission agreement upon the death of a resident. No fees shall accrue once all personal property belonging to the deceased resident is removed from the living unit.” This requirement was not met, as evidenced by:
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During today’s visit, Licensee, in front of LPA: a) Issued a credit of (-$2,112.39) to the account of R1 to wipe out the room and board charges from 04/26/2025 through 05/09/2025, essentially treating 04/25/2025 (the day R1 died) as the last billable day; b) Issued a credit of (-$114.88) to reimburse R1 for their one-time pest control product/incidental expense. The total credit was therefore (-$2,227.27), and given R1 had a balance owed of $1,341.99, this resulted in an excess refund payment of (-$885.28) to R1’s estate. These actions resolve the deficiency.
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Upon the death of 1 of 113 residents (R1), Licensee continued to allow fees to accrue after the deceased resident’s personal property was removed from the living unit. This posed a potential personal rights 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: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5