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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006451
Report Date: 05/14/2026
Date Signed: 05/14/2026 04:01:24 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/19/2025 and conducted by Evaluator Jenifer Tirre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250219124743
FACILITY NAME:IVY PARK AT LA PALMAFACILITY NUMBER:
306006451
ADMINISTRATOR:MUNOZ, JENNIFERFACILITY TYPE:
740
ADDRESS:5321 LA PALMA AVENUETELEPHONE:
(724) 739-8111
CITY:LA PALMASTATE: CAZIP CODE:
90623
CAPACITY:80CENSUS: 71DATE:
05/14/2026
UNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Jennifer MunozTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Staff handled resident roughly, causing skin tears
Staff did not notify authorized representative of incident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced visit to deliver findings on an investigation. LPA was greeted and granted entry into the facility by staff and explained the reason of the visit with Executive Director Jennifer Munoz.

During course of the investigation, the Department reviewed & obtained records including Physician’s report, Incident report, appraisal, and charting notes. Department also interviewed staff, residents and witness. The investigation revealed the following regarding allegations: Staff handled resident roughly, causing skin tears and Staff did not notify authorized representative of incident:

Regarding: Staff handled resident roughly, causing skin tears, Per Record review an incident report dated February 16, 2025, Resident (R1) sustained a skin tear on left forearm when care providers were assisting resident transfer using a Hoyer Lift from bed to wheelchair.
CONTINUED ON 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2026
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 22-AS-20250219124743
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: IVY PARK AT LA PALMA
FACILITY NUMBER: 306006451
VISIT DATE: 05/14/2026
NARRATIVE
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Resident charting notes dated same date February 16, 2025, noted during transfer resident hit arm on grab bar, resulting in a skin catching and tearing. Per charting notes a Med Technician provided skin care and a Nurse removed dressing to assess skin, notes stated family member requested R1 be transferred to hospital for care of tear.

Per interviews with staff members, five of five staff confirmed that R1 needed to be transferred from bed to wheelchair using two person assist with Hoyer lift. All five staff members stated that staff is trained to use Hoyer Lift via monthly training's and in services learning transfers and proper technique. Four of five staff stated that R1 would get anxious when having to be transferred using Hoyer lift and would begin moving abruptly. Per staff interviews, staff stated they would sometimes have to calm R1 and instruct resident to tuck arms inside sling to help prevent injuries. Per staff interviews staff stated that R1 had thin texture of skin and that R1 had chronic itching of skin and would constantly pick or scratch roughly at arm or dressings on arm.

Per interview with resident, R1 when asked why their arm was bandaged, R1 stated they got their arm caught in door due to being careless. R1 stated their arm did not hurt or itch and that this was the first time this has happened. R1 stated that they need help out of bed, to which they press a pendant and staff assist immediately. R1 stated that they feel safe at facility with staff and had no concerns. Interviews conducted with four residents who all get assisted with Hoyer Lift transfers stated that typically two staff help assist with transfer and staff inform residents to tuck their arms inside sling to avoid injuries. Four of four residents stated they have not been injured during transfers while using Hoyer Lift. Five of five residents stated they feel safe at facility and had no issues with staff’s competence of care being provided.

Regarding allegation: Staff did not notify authorized representative of incident: Per R1 Charting notes dated 2/16/25- 2/24/25, Staff member noted on 2/16/25 that incident occurred at 7:45am and report was typed at 11:06am. Notes stated for incident that family and primary doctor were notified of incident, however no time was noted.

Per interviews with staff, four of five staff members stated they would contact R1’s responsible party whenever changes occurred. Staff 1 (S1) stated that when incident occurred R1 contacted responsible party before staff contacted responsible party. S1 stated that policy is for staff to contact and complete report before end of shift that day.

Based on information gathered from complaint, the allegations Staff handled resident roughly, causing skin tears and Staff did not notify authorized representative of incident were deemed Unsubstantiated meaning that although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur as reported.

An exit interview was conducted with Executive Director Jennifer Munoz and copy of report was provided.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:

DATE: 05/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2026
LIC9099 (FAS) - (06/04)
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