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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604757
Report Date: 02/03/2025
Date Signed: 02/03/2025 10:48:50 AM

Document Has Been Signed on 02/03/2025 10:48 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
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 BONITAFACILITY NUMBER:
374604757
ADMINISTRATOR/
DIRECTOR:
NEWTON, RANDALFACILITY TYPE:
740
ADDRESS:3302 BONITA ROADTELEPHONE:
(619) 470-2220
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY: 96CENSUS: 66DATE:
02/03/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:39 AM
MET WITH:Randal NewtonTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced Case Management Visit.  LPA was greeted by and met with Executive Director Randal Newton, to discuss the purpose of the visit.

Today's visit is in response to the self reported medication error for Resident 1 (R1) (see LIC811 Confidential List of Names) received on January 30, 2025. It was reported that R1 was given Parkinson's disease medication instead of antibiotic. R1's Physician was notified as well as R1's responsible party. Physician instructed care team to monitor for side effects, but did not believe any side effects would occur.

Records review of R1's Physician's Report revealed that R1 has a primary diagnosis of senile degeneration of the brain and is not able to administer their own medications.

LPA interviewed staff and collected records. A wellness check was completed; no health or safety issues were identified. No deficiencies were cited or observed on this date. 

An exit interview was conducted with Randal Newton, who was provided with a copy of this report and Appeal Rights (LIC9056 03/22). Their signature confirms receipt of these documents.
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE: DATE: 02/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/03/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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