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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604455
Report Date: 09/11/2025
Date Signed: 09/11/2025 04:24:19 PM

Substantiated


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
09/04/2025 and conducted by Evaluator Ramon Serrano
COMPLAINT CONTROL NUMBER: 08-AS-20250904161054
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: 126DATE:
09/11/2025
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Trobell OranaTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff did not prevent resident from eloping from facility
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced complaint visit and also delivered findings regarding the above complaint allegation. LPA introduced himself and disclosed the purpose of the visit with Memory Care Director Trobell Orana.

Community Care Licensing (CCL) has investigated the above allegation. The investigation consisted of LPA observations, records review, interviews with staff and resident.

It was alleged that facility staff did not prevent Resident 1 (R1) from eloping from the facility. It was reported that R1 eloped from the facility and was not located for several hours.

R1's Physician's Report dated August 13, 2025 revealed R1 has a diagnosis of Major neurocognitive disorder. R1 is not able to leave the facility unsupervised and R1 becomes disoriented at times.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025
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 4
Control Number 08-AS-20250904161054
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: 09/11/2025
NARRATIVE
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R1's Individualized Service Plan dated August 15, 2025 states that R1 is ambulatory and is unable to leave the facility unsupervised. Service plan further states that R1 is required to wear their safety bracelet if they are in the assisted living section of the community.

LPA interviewed R1 who stated that less then a week ago they exited the facility without any supervision. R1 stated that they wanted to take a walk so they walked down the stairwell and exited the facility onto the sidewalk. R1 stated that they did not injure themselves during their walk but they did feel dehydrated. R1 stated that they now have a private caregiver who takes them for walks outside of the facility

LPA interviewed Staff 1 (S1) who stated that on the date of the incident a woman called the facility advising staff that a person was found walking down the sidewalk who appeared lost and confused. The woman was able to confirm with R1 their identity. S1 then drove to pick up R1 who was with law enforcement. S1 asked R1 "what happened." R1 replied that they went for a walk and got lost. S1 stated that R1 was located approximately three blocks from the facility. S1 was unable to confirm how long R1 was outside of the facility unsupervised.

LPA interviewed Staff 2 (S2) who stated that R1 eloped from the facility on the second day that R1 was admitted. S2 stated that R1 resides on the second floor in the assisted living section of the facility. S2 stated that R1 exited the facility from a stairwell on the second floor that exits onto the sidewalk. S2 stated that R1 was out of the community for approximately two hours. S2 stated that R1 was picked up by S1 and brought back to the facility. S2 stated that R1 now has a private caregiver that was provided by R1's responsible party.

On September 3, 2025 CCL received an incident report (IR) regarding R1. IR stated that on September 2, 2025 the facility received a telephone call from a neighbor advising them that R1 was seen walking by the nearby homes. R1 was immediately picked up by facility staff. R1 returned to the facility without any visible injuries. After R1 showed facility staff the exit they took, staff concluded that they "cleared the alarm" without realizing that a resident had exited the facility.
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 08-AS-20250904161054
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: 09/11/2025
NARRATIVE
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The Department has investigated the complaint alleging staff did not prevent R1 from eloping from facility. Based on evidence obtained R1 eloped from the facility on September 2, 2025. Accordingly, the above allegation is substantiated. This finding means that the preponderance of the evidence standard has been met and the allegation is valid. The deficiency is cited in accordance with California Code of Regulations, Title 22, Division 6, Chapter 8 and noted on the attached LIC 9099-D.

An exit interview was conducted, a plan of correction was developed by Trobell Orana and a copy of this report and Licensee/Appeal Rights (LIC 9058) were provided to Trobell Orana whose signature on this form confirms receipt of the documents.
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 08-AS-20250904161054
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/11/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/06/2025
Section Cited
CCR
87464(f)(1)
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87464 Basic Services (f)(1).... “Care and Supervision” means the facility assumes responsibility for…on going assistance with activities of daily living and the assumption of varying degrees of responsibility for the safety and well-being of residents.
This requirement was not met as evidenced by:
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Licensee agreed to conduct a full scale elopement driil and a training on elopements/absent without leave (AWOL), supervision for residents in care. This drill and training will be completed by POC date of 10/6/25. Licensee will provide LPA with a signed drill and training roster and training agenda.
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Based on LPA interviews and records review the licensee did not provide R1 supervision. 1 in 1 of 126 persons in care [R1] which posed a potential health and safety risk to persons in care.
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As of 9/2/25Tha R1 has a private caregiver that is with R1 24/7.
This is an amended lic9099D that was orginally delivered on 9/11/25
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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: Robyn Clark
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4