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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604455
Report Date: 11/07/2025
Date Signed: 11/07/2025 10:09:23 AM

Unsubstantiated


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
08/05/2024 and conducted by Evaluator Grace Donato
COMPLAINT CONTROL NUMBER: 08-AS-20240805130104
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: DATE:
11/07/2025
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Diana WeinsteinTIME COMPLETED:
09:16 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Neglect to resident resulting in serious bodily injury.
Staff did not ensure resident's needs were met
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 11/7/2025, LPA Grace Donato conducted a telephone interview with the facility to deliver findings. LPA spoke with Executive Director, Diana Weinstein and explained the purpose of the call.

Regarding the allegation of neglect to resident resulting in serious bodily injury, resident (R1) was sent to the hospital and had undergone surgery. According to records, on 7/15/2024, during medication pass, R1 reported experiencing pain. R1 was asked if he/she had a fall but kept denying. PRN medication was given but was ineffective. Staff asked family to send R1 to hospital for further evaluation. On the same day, R1 was sent to hospital and was evaluated.

For the allegation of staff did not ensure resident's needs were met, based on the records reviewed, there is constant alert charting for R1. There are also notes from facility staff about R1s behaviors and daily activities.

Based on records review, the department has determined that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Report is reviewed and a copy is provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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