Ivy Park At San Tomas

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Allegation investigated: Staff did not change resident timely Resident missed medication Due to neglect, resident sustained a pressure injury Staff did not follow physician's orders Staff do not meet resident's feeding needs

Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced complaint visit to deliver complaint findings. LPA met with Executive Director (ED) Karen Nickolai. LPA stated the purpose of the visit. On 4/11/2025 the Department received a complaint with the above allegations. On 4/18/2025 and 7/8/2025 the Department conducted complaint investigation visits, and interviewed 7 Staff (S1 to S7), 7 Residents (R1 to R7). On 4/22/2025, 4/2/2026, 4/3/2026, the Department interviewed Reporting Party (RP). RP states a resident, referred to as R1, was not changed in timely manner. Page 1 of 5 Unsubstantiatedthe state’s words, verbatim · CDSS document, Apr 22, 2026 · control 26-AS-20250411110434

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Allegation investigated: Facility did not provide assistance with dressing in a timely manner. Facility did not provide food service.

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced investigation visit to deliver the investigation finding and met with Executive Director (ED) Karen Nickolai. On 10/21/2025, the Department received a complaint with the allegations that facility did not provide assistance with dressing in a timely manner and facility did not provide food service. On 10/30/2025, the Department conducted an initial investigation visit. LPA interviewed ED, 7 staff, and 4 residents. LPA observed all residents of the memory care unit were in activity room. Continue on lIC9099-C. Page 1 of 3. Unfoundedthe state’s words, verbatim · CDSS document, Mar 18, 2026 · control 26-AS-20251021105638

Allegation investigated: Staff did not administer medication as prescribed.

Licensing Program Analyst (LPA) Marcella Tarin conducted an unannounced investigation visit to deliver complaint findings. LPA met with Executive Director (ED) Karen Nickolai. LPA stated the purpose of the visit. On 10/13/2025 the Department received a complaint with the above allegation. On 10/16/2025, the Department conducted a complaint investigation visit, and interviewed the Executive Director (ED), 5 Staff (S1 to S5) and 4 Residents (R1 to R4). LPA requested pertinent documentation to include but not limited to staff schedules, Medication Administration Records (MARs) and resident physician's reports. It has been alleged staff did not administer medication as prescribed sometime in October 2025. Page 1 of 2 Unfoundedthe state’s words, verbatim · CDSS document, Jan 28, 2026 · control 26-AS-20251013112243

Allegation investigated: Facility does not provide blankets for resident Facility does not make medical appointments to address resident's change in condition

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced complaint investigation visit and met with Karen Nickolai, Administrator (ADM). On 09/24/2025, the department received a complaint with the above allegations. On 09/25/2025, LPA Marrufo conducted an initial complaint investigation visit. On 11/06/2025, LPA Marrufo conducted an additional complaint investigation visit. Allegation: Facility does not provide blankets for resident - Unfounded When the department received the complaint, it was alleged that the facility was not providing a blanket for resident R1’s bed. See LIC9099-C pages for more information. Page 1 of 3. Unfoundedthe state’s words, verbatim · CDSS document, Jan 28, 2026 · control 26-AS-20250924091243

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Allegation investigated: Resident sustained multiple falls while in care due to lack of staff supervision Resident sustained multiple injuries while in care Facility is not kept free of pests Staff are not following resident's care plan Staff prevented resident in care from leaving facility common area Resident in care was not allowed to participate in activities Staff did not provide proper cleaning services to resident in care Staff did not ensure hot water was made available to residents in care Staff did not prevent residents from stealing other resident's personal items

On 12/30/25 Licensing Program Analyst (LPA) Marcela Yanez conducted an unannounced complaint investigation visit to deliver findings. LPA announced the purpose of the visit and met with Karen Nickolai, Administrator On 09/23/24 the department recieved a complaint with the above allegations On 09/26/24 LPA Kabarati conducted an initial complaint investigation visit and obtained pertinent documents. It was alleged that the facility did not prevent resident from falling on several occasions. Based on documentation 06/21/2024: No fall is noted. The fall nearest to the date of 06/21/2024 occurred on 06/18/2024. The fall was recorded/captured by the Safely You technology located in each of the residents room in the facility. R1 fell and hit his/her head and no injuries were noted and R1 denied any pain or discomfort. page 1 of 9 Unsubstantiatedthe state’s words, verbatim · CDSS document, Dec 30, 2025 · control 26-AS-20240923130821

Allegation investigated: Staff did not seek timely medical care for resident in care Staff did not attend to resident in care in a timely manner

Licensing Program Analyst (LPA) Marcela Yanez arrived unannounced to deliver the finding for the above allegations and met with Jessica Pryor, Regional Operations Specialist (ROS). On 09/23/24, the Department received the complaint. On 09/26/24, the initial complaint investigation was conducted. The following documents were obtained for this investigation to include the resident roster, staff schedule, 3 resident’s physician’s report, care plan, progress notes, face sheet, centrally stored medication record, medication administration record, resident (R1)’s medical records, and police report. It was alleged that the staff did not seek timely medical care and did not attend to resident (R1) care in a timely manner when R1 had a fall on 08/05/24. Page 1 of 4 Substantiatedthe state’s words, verbatim · CDSS document, Aug 27, 2025 · control 26-AS-20240923130821

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Allegation investigated: Facility did not ensure sufficient number of staff at all times to provide the services necessary to meet the resident's needs. Staff are not trained in assisting residents with medication.

On 10/24/2024 the Department received a complaint with the above allegations. On 10/31/2024 LPAs conducted the initial 10-day investigation. On 10/31/2024 LPAs interviewed 2 staff. 2 Out of 2 Staff state the facility has enough staff to provide the services necessary to meet resident’s needs. On 7/8/2025 LPAs interviewed 4 staff. 4 out of 4 staff state the facility has enough staff to meet residents’ needs. Health Services Director (HSD) states the facility has enough staff to meet residents' needs. On 7/8/2025, LPAs interviewed 7 Residents. 4 Out of 7 Residents stated the facility has enough staff to provide the services necessary to meet the residents’ needs. 3 Out of 7 residents were unable to provide an answer to LPAs questions. Page 1 of 2. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jul 8, 2025 · control 26-AS-20241024102358

Allegation investigated: Facility Staff did not complete their required training Hazardous items are accessible to residents in care.

Licensing Program Analyst (LPA) Monter conducted an unannounced complaint inspection to deliver the findings on the above allegation. LPA met with Regional Operations Specialist Krystal Jenkins. On June 17, 2025, the Department received a complaint alleging Facility Staff did not complete their required training. On June 23, 2025, LPA Manuel Monter interviewed Staff S1-S4. All staff members interviewed stated they have received their required 40 hours of initial training. Page 1 Out of 3 Unfoundedthe state’s words, verbatim · CDSS document, Jul 8, 2025 · control 26-AS-20250617095450

Allegation investigated: Staff are not implementing proper infection control practices at the facility Staff did not provide adequate laundry services to residents in care Staff did not provide good quality foods to residents in care Residents sustained multiple falls due to insufficient staff at the facility Staff did not order resident's medication in a timely manner

Licensing Program Analyst (LPA) Monter conducted an unannounced complaint inspection to deliver the findings on the above allegation. LPA met with Regional Operations Specialist Krystal Jenkins. On January 27, 2025, the Department received a complaint alleging Staff are not implementing proper infection control practices at the facility / Staff did not provide good quality foods to residents in care. It has also been alleged the food was contaminated. Page 1 Out of 6. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jul 8, 2025 · control 26-AS-20250127135342

Allegation investigated: Staff do not provide adequate supervision to residents in care. Staff are under the influence of alcohol and drugs while caring for residents. Staff are mismanaging residents' medications. Administrator is not present on facility premises for sufficient number of hours.

On 6/26/2025 Licensing Program Analyst (LPA) Grace Donato conducted an unannounced complaint investigation visit at the facility. LPA met with Regional Operations Specialist (ROS), Jessica Pryor and explained the purpose of the visit. Regarding the allegation of Staff do not provide adequate supervision to residents in care, Reporting Party (RP) stated that there has been many incidents of falls and residents passing away and NOC (night) shift employees disappearances. LPA Donato interviewed seven responsible parties. F1 mentioned that it is a nice, new facility and all the staff members are very kind and pleasant. There are many daily activities that R1 participates in and really enjoys the constant music and conversations. Overall, F1 is happy with the staff and how friendly and caring they are. page 1 of 3 Unsubstantiatedthe state’s words, verbatim · CDSS document, Jun 26, 2025 · control 26-AS-20250515114342

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Allegation investigated: Resident was covered in feces on hands and clothes due to staff neglect. Resident sustained a laceration on body but staff is unable to provide details of the injury.

Unannounced complaint visit made out to this facility on 12/15/2024 by Licensing Program Analyst (LPA) Charlie Yang who was met by the weekend manager on duty, Jennifer DeLeon, who also held the role as the Memory Care Coordinator (Reflections Coordinator) at this time. A brief interview was conducted with the facility representative Jennifer DeLeon at this time. Current census was 30 residents. The purpose of this visit was to inform this facility, and its representative Jennifer DeLeon, that an ongoing investigation has been completed and the following findings were being delivered at this time. Based on interviews conducted during the course of this investigation, it was learned that this facility was licensed to accept and retain a total of 82 residents. It was learned that this facility accepted and retained residents diagnosed with varying levels of cognitive issues. It was learned that facility residents occupied both the first and second floors at this time. It was observed thathe state’s words, verbatim · CDSS document, Dec 15, 2024 · control 26-AS-20231024163756

Allegation investigated: Neglect/Lack of supervision by staff to a resident who assaulted another resident.

Unannounced complaint visit made out to this facility on 12/15/2024 by Licensing Program Analyst (LPA) Charlie Yang who was met by the weekend manager on duty, Jennifer DeLeon, who also held the role as the Memory Care Coordinator (Reflections Coordinator) at this time. A brief interview was conducted with the facility representative Jennifer DeLeon at this time. Current census was 30 residents. The purpose of this visit was to inform this facility, and its representative Jennifer DeLeon, that an ongoing investigation has been completed and the following findings were being delivered at this time. Based on interviews conducted during the course of this investigation, it was learned that this facility was licensed to accept and retain a total of 82 residents. It was learned that this facility accepted and retained residents diagnosed with varying levels of cognitive issues. It was learned that facility residents occupied both the first and second floors at this time. It was observed thathe state’s words, verbatim · CDSS document, Dec 15, 2024 · control 26-AS-20231116110403

Allegation investigated: Staff left medication unattended and accessible to residents in care.

Licensing Program Analysts (LPAs) Christine Dolores and Santino Fortes arrived unannounced to open the initial complaint investigation. LPAs met with Executive Director, Kenia Sanchez. On 10/07/2024, the Department received the complaint. On 10/17/2024, the initial complaint investigation was conducted. Documents were obtained to include the staff schedule for September 2024, resident roster, and a staff member’s telephone number. It was alleged that when staff (S1) assisted another resident, S1 had left "a stack" of bubble pack medications unattended and accessible to residents in care in the common area of the facility. Page 1 of 2. Unfoundedthe state’s words, verbatim · CDSS document, Oct 17, 2024 · control 26-AS-20241007160553

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.