Ivy Park at La Palma

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced visit for the purpose of conducting a required one-year annual inspection. LPA was greeted, granted entry by staff and explained the reason for the visit. Structure: The facility has two level structure and licensed for 80 non-ambulatory residents and has a hospice waiver for 15. The facility currently has 72 residents and 70 residents were present during the visit. The facility consist of Assisted Living and Memory Care. Bedrooms: Seven random resident bedrooms/restrooms were inspected and all had the required furnishings: bed, lamp, chair, and storage space. Bathroom(s): Bathrooms are equipped with a working toilet, wash basin, and shower. Hot water measured in between 115.1 – 118 degrees F. Kitchen/Food Service: A food supply that meets regulation requirements was observed. The facility receives four shipments from two different carriers a week. Food temperature logs were observed, and Freezer/Refrigerator logs were observed. Temperature logs are updated daily. Food temperature logs are recorded during each meal. Client & Staff Files: Resident and staff files are located on the first floor in the business office and the Executive Directors office. File Review: Seven resident files and seven staff files were reviewed during the inspection. Medications/First-Aid Kit: Resident medications are stored in the medication carts and stored on the second floor in the wellness room. A first aid kit with all the required elements was observed mounted on the wall in the wellness room near the medication carts. Continued on LIC809C Medication Review: Seven resident medications were reviewed during the visit. No discrepancies were observed. Medication is being administered as prescribed. Backyard/Exterior: The exterior portion of the facility is clean and organized. Walkways are free of obstruction. Tables and chairs were observed and there was plenty of shade in the outside portion of the facility. Bodies of Water: None Smoke/Carbon Monoxide Detectors: Smoke and sprinkler systems are serviced annually by Telgian. The last inspection was conducted June 4, 2026. Fire Extinguisher: Fire extinguisher were observed mounted on wall throughout the facility. An emergency evacuation drill: Was conducted June 16, 2026. Evacuation drills are conducted monthly. Emergency Phone Numbers, House Rules, Exit Plan & Menu: Several facility postings are posted and available for review on the main postings board near the elevator. Additional Comments: Licensing fees are current. Contact information was reviewed and and updated. Seven staff were interview and three residents were interviewed during the inspection. No deficiencies are being cited as a result of today’s inspection. An exit interview conducted, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jul 8, 2026

Allegation investigated: Staff handled resident roughly, causing skin tears Staff did not notify authorized representative of incident

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 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.the state’s words, verbatim · CDSS document, May 14, 2026 · control 22-AS-20250219124743

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit. The purpose of today's visit was to conduct a case management. LPA Tea was greeted and granted entry into the facility by Executive Director (ED) Jennifer Munoz. On this day LPA Tea amended LIC809D dated 09/26/2024. LPA reviewed amended report with ED Munoz. An exit interview was conducted with Executive Director Jennifer Munoz. A copy of this report and amended LIC809D was provided to the facilitythe state’s words, verbatim · CDSS document, Apr 23, 2026

Type of visit: Required - 1 Year

On August 1, 2025, Licensing Program Analyst’s (LPA’s) Jenifer Tirre and Eboni Bentley conducted an unannounced required visit using the CARE Inspection Tool. LPA’s were greeted by staff and granted entry after stating the purpose of the visit. Administrator (AD) Jennifer Munoz arrived shortly after and was present to assist with the facility inspection on today's date. The facility is licensed for Eighty (80) Non-Ambulatory residents, of which four (4) may be bedridden with approved hospice waiver for Fifteen (15) residents. Currently, there are five (5) Hospice residents present during today’s visit. Facility is a two story building with 59 units combined in both Assisted Living and Memory Care with total capacity of 80. Facility is approved for Delayed Egress. Facility serves as a Residential Care Facility For Elderly and Dementia Residents. At around 9:00AM, LPA’s conducted a tour of the physical plant accompanied by Executive Director Jennifer Munoz, and the following was observed: There were no bodies of water on the premises. Rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the client's personal belongings was observed. Bathrooms were operational with water temperature measured between 110.8 to 116.4 degrees F inside facility restrooms. A comfortable temperature of 72 degrees F. was maintained in the facility. The kitchen was inspected, and facility has sufficient perishable and non-perishable foods. Facility has Easy Meal food kits which serve 25 individuals per package for emergency food and two large water drums of emergency water. Storage areas for sharps objects and cleaning supplies were stored and not accessible to residents. Facility has multiple fire extinguishers. During today’s visit eight (8) fire extinguishers were observed to be fully charged, mounted and in compliance with date of service of November 12, 2024. Facility has total of two evacuation chairs at end of each stairwell. CONTINUED ON 809C A review of the Medication Records Administration (MAR) was conducted, and LPA observed the records are in compliance. During the visit, LPA’s observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPA’s observed the facility has supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. LPA’s observed First Aid Kit was maintained. A working landline phone was operational. The last fire drill was conducted on 7/18/2025. Facility has operating smoke detectors and audible alarms which LPA's observed Last fire inspection paperwork was completed by TRL Systems completed on March 5, 2025. Proof of liability insurance was provided during visit. The facility has current liability insurance on file effective 5/1/2025 – 5/1/2026. A review of seven residents (R1-R7) service files and eight staff (S1-S8) personnel files revealed to be complete. Interviews were conducted with staff and residents. The facility has the current administrator's certification on file for Jennifer Munoz # 7003108740 - Expiration 10/27/2025 No deficiencies during this inspection visit. An exit interview was conducted with Executive Director Jennifer Munoz , and a copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 1, 2025

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Michael Tea conducted a case management visit to follow up on an incident report received by Community Care Licensing (CCL) on September 23, 2024 submitted by Executive Director (ED), Jennifer Munoz. LPA was greeted and allowed entrance into the facility by Executive Chef, Jeremai Soto and explained the reason for the visit. ED Munoz arrived shortly to assist during the visit. During the case management visit, LPA and ED toured the facility. LPA conducted health and safety checks on residents present and confirmed they were doing well and observed no health and safety issues besides residents who have Covid-19. Facility is following public health Covid-19 protocol. LPA observed the facility to be clean and organized and found no health and safety issues. LPA checked perishable and non-perishable food supply and it was adequately stocked at time of visit. The purpose of this visit is to discuss the special incident report (LIC624) submitted that occurred on September 13, 2024 around 8:15 PM where Staff 1 (S1) observed Staff 2 (S2) physically placed their hand over Resident 1’s (R1) mouth who resides in Memory Care. LPA requested resident file, staff files, staff and resident roster and internal investigation summary report. LPA interviewed with ED Munoz, Memory Care Director (MCD) Samantha Shashkin and R1. S1 reported the incident at the end of their shift to the MCD Shashkin. ED Munoz conducted an internal investigation the following day, September 14, 2024. ED Munoz along with MCD Shashkin interviewed Memory Care staff, including S2 right before they started their shift. Management has pulled S2 off the floor and has placed them on administrative leave/suspension and employee status is pending after investigation. The ombudsman was contacted and local law enforcement was notified and reported the incident to them. The internal investigation was closed on September 18, 2024. Facility management concluded they were going to terminate S2 employment. (Report continued on LIC809-C) There were no health and safety concerns observed in the areas inspected. Based on the observations made during today’s visit the following deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Executive Director, Jennifer Munoz and a copy of this report and appeal rights was provided at exitthe state’s words, verbatim · CDSS document, Sep 26, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Sep 27, 2024

Personal Rights of Residents in All Facilities ... Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by: Based on LPA's investigation staff violated personal rights of resident by physically covering the mouth of the resident with their hand in order to subdue resident's reaction.the state’s words, verbatim · CDSS document, Sep 26, 2024

Plan of correction: Executive Director will conduct inservice training on Personal Rights of Residents and elderly abuse and provide proof of training by POC due date. *** THIS IS AN AMENDED REPORT ***

Type of visit: Prelicensing

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made a scheduled visit to the facility to follow up on the initial pre-licensing visit conducted by LPA Celine De Perio on May 17, 2024. LPA was greeted and granted entry by the facility's front desk staff after introducing himself and stating the reason for the visit. Executive Director Jennifer Munoz was present to assist with the visit. The licensing update is related to a change of ownership with residents in care present. LPA accompanied by Executive Director conducted a tour of the facility's indoor and outdoor physical plant. The facility is a two-level building with a total of 59 units and a total capacity of 80 residents. On the day of the visit, there were 69 residents admitted to the facility, 22 of which living in the facility's memory care unit. Occupied living units were toured on both the ground level and the upper level and were verified to include all necessary items of furniture. Bathrooms are equipped with rails and showers are observed to be including anti-slip material. Water temperatures were measured on both levels to be within the required range. Required postings are verified to be present. There is adequate outdoor space with shade for the residents both in Assisted Living as well as in Memory Care. The facility is verified to be clean and in good repair. Facility residents observed appear to be relaxed and well taken care of. The facility is also equipped with a functional call system with pull cords located in each bedroom and bathroom as well as additional individual pendants available by personal choice. The facility has a valid current fire clearance for 76 non-ambulatory and 4 bedridden residents. Carbon monoxide detectors and sprinklers are wired. Proof of operation being verified was provided during the visit. Evacuation chairs are present in each of the two evacuation stairwells. The memory care outdoor area is equipped with delayed egress doors leading out into the yard and outside of the facility. CONTINUED ON FORM LIC809-C CONTINUED FROM FORM LIC809 LPA reviewed the facility's fire clearance issued by the Orange County Fire Authority on November 30, 2023 as well as the facility's Emergency and Disaster Plan and Infection Control document. LPA observed that the fire clearance does not include an explicit mention of the delayed egress in use to exit the memory care unit into the secure courtyard as well as to exit the courtyard onto the facility's parking lot. LPA provided a consultation on the requirement from Title 22 of the California Code of Regulations Section 87705(k)(2) regarding the Care of Persons with Dementia indicating that :"The licensee shall ensure that the fire clearance includes approval of delayed egress devices". Licensee will request an update of the fire clearance to the Fire Marshall in order for licensing to be approved. Proof of liability insurance was provided during the visit. LPA requested and obtained the list of staff members as well as the current resident roster. Five staff records and five resident records were randomly selected and reviewed to include all necessary components. An exit interview was conducted and a copy of this report along with two Technical Assistance Advisory Notes were provided to a facility representative. This report was amended to add the expected corrections required ahead of the new license being issued. A signed copy will be obtained and kept in the facility file.the state’s words, verbatim · CDSS document, Jul 17, 2024

The state marks this report as 4 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.