Ivy Park at Escondido

Type of visit: Required - 1 Year

On 05/26/26, Licensing Program Analyst (LPA) Aziz Faizi made an unannounced visit to the facility to conduct a required annual inspection. LPA was greeted and granted entry by Executive Director Kimberly Dominy who was informed of the purpose of the visit. The facility is a two-story residential home with current census of 83 residents. There are no pools or known firearms on the premises. The facility offers a wide range of on-site amenities including a salon, a movie theater, multiple dining rooms, and a fitness center for the residents. LPA toured the facility's exterior and observed outdoor pathways were free of obstructions. Outdoor shaded seating area is available for the clients in care. The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. LPA toured the kitchen and observed the facility has a two-day supply of perishable foods and more than a seven-day supply of non-perishable foods, which are stored in a safe and healthy manner. LPA observed knives and sharp instruments secured inaccessible to residents in the kitchen. Laundry equipment was in good working condition. Both the smoke detector and carbon monoxide detector were operational, and the hot water temperature was 113.6°F. Fire extinguishers equipped throughout the building are maintained in accordance with the department's safety requirements expiring on 3/17/2027. Adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate expiring in 05/30/2027. Continued from LIC809 LPA reviewed files for eight (8) staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Eight (8) resident files were reviewed and contained all required documentation. All resident medications were securely locked. LPA reviewed medications for eight (8) residents, confirming that all medications were listed on the Medication Administration Record (MAR) and accounted for. LPAs reviewed the facility’s emergency and disaster plan, including documentation of the last fire/earthquake drill conducted on 05/06/2026, which met department requirements. All facility exits were clear of obstructions. No deficiencies were cited during the visit. An exit interview was conducted, during which this report was reviewed and provided.the state’s words, verbatim · CDSS document, May 26, 2026

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPAs) Janira Arreola, Imaculada Vasquez, and Toni Nwala, conducted an unannounced visit to the facility in order to conduct a case management. LPA met with Administrator, Samuel De Guzman, who was informed of the purpose of the visit. During the visit, LPA conducted interviews, documented observations, conducted a walk through, and conducted records review. A health and safety check was conducted on the facility and residents, no immediate health or safety issues were observed. During the time of the visit there was a deficiency identified. (1) Resident, Resident #1 (R1) did not have an incident report done for the resident's death within the required time frame. Therefore a deficiency was cited and a plan of correction was documented. An exit interview was conducted where this report, appeal rights, and deficiency page was reviewed and provided.the state’s words, verbatim · CDSS document, Feb 19, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(A) · Plan of correction due date: Feb 25, 2026

87211Reporting Requirements(a)Each licensee shall furnish to the licensing agency such reports...(1)A written report shall be submitted to the licensing agency..for the resident within seven days of the occurrence of...(A)Death of any resident from any cause regardless of where the death occurred...a hospital, en route to or from a hospital, or visiting away from the facility. This requirment was not met as evidenced by: Based on interview and record review an incident report was not submitted for R1. This poses a potential health safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Feb 19, 2026

Plan of correction: The administrator agreed to conduct an in service with staff on the reporting requirements cited in this section and submit proof by the POC due date. The administrator agreed to submit an incident report for R1 within the next business day.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Janira Arreola, made an announced visit to the facility in order to conduct a pre licensing inspection. LPA met with current Administrator, Samuel De Guzman, who was informed of the purpose of the visit. LPA conducted interviews, records review and a walk through of the facility. The facility is applying for a change in ownership for a residential care facility for the elderly, with capacity of 123 residents. The fire inspection was conducted by the local fire jurisdiction and approved for 116 non-ambulatory residents and (7) bedridden residents in rooms 108, 109, 110, 111, 112, 113, AND 114 only. The facility does not have a pool or firearms. The building is (2) stories comprised of resident activity rooms, bedrooms, bathroom, staff offices, laundry and storage spaces. The resident bedrooms were observed with the required furniture. The physical plant was observed to be clean and sanitary. LPA observed hygiene supplies, PPE supplies, and cleaning supplies are stored. The cleaning and hazardous items were observed to be locked and inaccessible to residents. LPA was provided with smoke and carbon monoxide alarm inspections showing they are in working condition. The outdoor area was free of any hazards and had a shaded area for residents and an emergency exit. The kitchen had the ability to prepared food is a clean and safe environment. LPA observed the food supply met the department requirements. The hot water temp was measured at 116F. The facility has a land line at (760) 747-4888 which is operational. Common spaces are available for clients to engage in activities and posted activity calendar and menus. LPA observed areas were the staff and resident files will be kept. Emergency supplies are retained by the facility, including complete first aid kits, emergency water food and lighting. The facility is currently operating with residents and staff. LPA conducted records review of resident records and found required documentation. LPA reviewed the staff roster and confirmed all staff have criminal record clearance. At this time there are no objections for the applicant to proceed in the prelicensing process. An exit interview was conducted where a copy of this report was reviewed and provided.the state’s words, verbatim · CDSS document, Apr 29, 2025