Ivy Park at Lake Merritt

Allegation investigated: Staff did not prevent a resident from engaging in inappropriate behaviors with another resident Staff are not meeting residents needs Staff did not prevent a resident from entering another residents room

On 06/03/2026 at 3:25 PM, Licensing Program Analyst (LPA) David Doidge arrived unannounced to (conduct an initial 10-day complaint investigation and to deliver findings) regarding the allegation(s) above. LPA met with Assisted Living Director Jocelyn Fabros and explained the purpose of the visit. During the course of the investigation, LPAs obtained copies of the Physician’s Reports, Appraisals Needs and Services for three (3) residents. LPAs also interviewed R1, R3, R4 and R5 Allegation: Lack of supervision resulting to resident sustaining injury from assault by another resident. Investigation Findings: It was reported to the department that a resident grouped another resident and was able to do so due to a lack of caregivers present. Continued on LIC9099-C Unsubstantiated Continued from LIC9099 W1 was near R2 when R1 came up and grouped R2. W1 yelled at R1 and a Medical Technician, (Med-Tech) came out to assist. W1 said W1 did not look for staff, nor yell for staff to assist. W1 only yelled at R1 which prompted the Med-Tech to come assist. S1 reported the behavior to the department in an Unusual Incident Report (LIC624) and reported it to both responsible parties. S1 informed LPA that R1 is new to the community. R1 has a lack of impulse control and dementia. LPA confirmed this by reviewing R1’s Physician’s report. S1 informed LPA that R1 will touch other residents or staff and ask if that person wants to be R1’s friend. R1’s does this in a friendly manner that can be interpreted as sexual due to R1’s impulse control and hand placement. S1 informed LPA staff will redirect R1 and remind R1 not to touch. S1 has said this behavior has never escalated beyond the initial touch and over the last few weeks has all but stopped. LPA reviewed staff roster and schedule. LPA toured the facility and counted six (6) staff present. R1 does not require one-on-one supervision, and staff were within eyesight while LPA toured the facility. R1 was seen dancing and socializing with many other residents. R3, R1’s roommate informed LPA that R1 has never exhibited those behaviors in their room, nor has R1 brought someone into the joint room. Based on interviews conducted and LPAs observations the above allegation is UNSUBSTANTIATED. Allegation: Staff are not meeting residents needs Investigation Findings: It was reported to the department that a visitor had to assist a resident in finding a staff member to assist, and that the facility seems to rely on goodwill visitors to assist residents. W1 stated W1 will go up to residents and that look like they need assistance and guide them to find a staff member. W1 stated W1 does not seek a staff member first. W1 admitted to taking it upon W1’s self to assist and thus feels there is a lack of staff. LPA reviewed the facility staff roster and did a head count confirming there was plenty of staff present to assist residents. LPA interviewed R1, R3 and R4 separately. Each stated they feel their needs are being met and feel there are sufficient staff to assist. Based on interviews conducted and LPA observations the above allegation is UNSUBSTANTIATED. Allegations: Staff did not prevent a resident from entering another residents room Investigation Findings: It was reported to the department that one resident was seen entering a room of two other residents, both of whom shoved the resident out. W1 reporting seeing R5 walk into a room that R5 does not occupy and being shoved out by the two residents who do occupy that room. W1 stated W1 had to intervene, take R5’s arm and lead R5 away. Again, W1 did not seek staff assistance, nor look for staff before helping. LPA spoke with S1 and reviewed R5’s physician’s report. R5 is visually impaired and uses handrails along to walls to navigate. R5 was not intentionally trying to gain access to another resident’s room. R5 simply got lost and missed R5’s room due to R5’s lack of vision. LPA toured the facility and noted residents do keep their doors open. As such, any resident can walk into another’s room though LPA did not observe this happening. S1 informed LPA that staff are working with R5 to assist R5 in better memorizing the layout of the facility and finding R5’s room, however with R5 having dementia, R5 is having some difficulty. To mitigate this, staff are reminded to look out for R5 and offer a redirect should R5 seem lost. Based on interviews conducted and LPA observations the above allegation is UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. No deficiencies were cited during this inspection. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Jun 3, 2026 · control 15-AS-20260518112244

Allegation investigated: Due to lack of supervision, resident from the 2nd floor (memory care) accessed the elevator up to the 3rd floor

On 05/29/2026 at 4:15 PM, Licensing Program Analyst (LPA) David Doidge arrived unannounced to conduct an initial 10-day complaint investigation and to deliver findings regarding the allegation above. LPA met with Executive Director Daniela Rivas and explained the purpose of the visit. During the course of the investigation, LPA obtained copies of the Physician’s Reports, Appraisals Needs and Services for one resident (R1). LPA interviewed S1. Allegation: Due to lack of supervision, resident from the 2nd floor (memory care) accessed the elevator up to the 3rd floor Investigation Findings: It was reported to the department that a resident was able to access the elevator and ride it from one floor to another. The facility consists of three floors: ground, first and second. Continued on LIC9099-C Unsubstantiated Continued on LIC9099 S1 informed LPA that R1 rode the elevator from the second floor down to the first floor. R1 frequently waits by the elevator on the second floor to ride it down to the first floor to visit with residents who live on the first floor. Residents are allowed to go between floors to visit one another and for activities. The elevator can only be called with a key fob issued to staff, however once in the elevator anyone can press a floor and go to that floor. To leave the facility one would have to walk past the concierge desk which is always staffed. Staff are aware of R1’s behavior and look out for R1. The concierges also know R1 will ride the elevator and look out for R1 to prevent R1 from walking out the front door. There are no other direct exits one could take without a staff member seeing that could lead to a resident eloping. LPA reviewed the staff roster that shows six staff per floor during wake hours. LPA walked the facility and observed six staff on both floors. Based on interview and LPA’s observation the above allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED. No deficiencies were cited during this inspection.the state’s words, verbatim · CDSS document, May 29, 2026 · control 15-AS-20260521093633

Allegation investigated: Facility elevator is in disrepair.

On 05/19/2026 at 12:30 PM, Licensing Program Analyst (LPAs) David Doidge and Carol Folwer arrived unannounced to conduct an initial 10-day complaint investigation and deliver findings regarding the allegations above. LPAs met with Executive Director Daniela Riva sand explained the purpose of the visit. During the course of the investigation, LPAs interviewed staff and toured the facility using both elevators. Allegation: Facility elevator is in disrepair Investigation Findings: It was reported to the department that the general manager of the facility is forcing staff to use an unworking elevator even though there is a working one which is causing an unsafe environment. S1 reported that the door sensor to the facility’s freight elevator is broken causing the door to slowly close. Continued on LIC9099-C Unsubstantiated Continued from LIC9099 S1 reported that the elevator is still safe to use, staff have been updating as to the circumstances and have the option to use whichever elevator they wish. S1 and S2 both reported no mandates nor obligation on staff as to which elevator to use. LPAs rode the freight elevator and observed that the door will close about a quarter of the way, then open and close in the same manner three to four times. The elevator door sensor will then alarm as it slowly closes. Once closed the elevator operates as normal. S1 informed LPAs that there is a service plan to change the door sensor. S1 reported that the company servicing the elevator, Otis, is currently sourcing the part and once available will change the senor. LPAs observed staff using both elevators freely, and both elevators in operational condition. Staff riding on the elevators reported no mandate for staff on elevator use. Staff did mention that management prefers staff use the freight elevators for building tasks, but there is no restrictions in place. Based on interviews conducted and LPAs observations the above allegation is UNSUBSTANTIATED. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. No deficiencies were cited during this inspection. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, May 19, 2026 · control 15-AS-20260518131634

Type of visit: Case Management - Health Checks

On 05/15/2026 at 10:30 AM, Licensing Program Analysts (LPA) David Doidge arrived unannounced to conduct a health and safety check. LPA met with Executive Director Daniela Rivas and explained the purpose of the visit. The LPA toured the interior and exterior of the facility, including but not limited to, residents’ rooms, bathrooms, kitchen, common areas, and the backyard. The LPA observed adequate lighting for the comfort and safety of residents in all rooms. Inside and outside areas are free of obstruction and no bodies of water. The temperature in the dining room was measured at 70.7 degrees Fahrenheit and the maximum hot water temperature was measured at 117 degrees Fahrenheit. There is more than the minimum of a one week supply of nonperishable foods and 2 days of perishable foods. Smoke and carbon monoxide detectors were in operating condition. Fire extinguishers were fully charged and last serviced on 09/16/2025. The medications were stored in a locked cabinet. First aid kit was observed to be complete. No citations were issued during the inspection. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, May 15, 2026

Type of visit: Case Management - Other

On 01/26/2026 at 01:30 PM, Licensing Program Analyst (LPA) David Doidge conducted a face to face Component III presentation. LPAs met with Executive Director Grant Haywood. LPA presented Component III power point and discussed the regulations embodied in the presentation. LPA observed Administrator gained knowledge about running and maintaining the facility in accordance with Title 22 regulations. LPA concluded Component III. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Jan 26, 2026

Type of visit: Prelicensing

On 01/26/2026 at 10:10 AM, Licensing Program Analyst (LPA) David Doidge conducted a Pre-licensing Inspection. LPA met with Executive Director Grant Haywood and explained the purpose of the visit. LPA toured facility including but not limited to resident's bedrooms, bathrooms, dining area, kitchen, common areas, and outdoor area. LPA observed lighting in all rooms. Hot water was measured at 118.5 degrees Fahrenheit in a resident's bathroom. Facility bathrooms have grab bars and non-skid mats. One week supply of nonperishable and 2-day supply of perishable foods were available. Facility orders food twice a week. Freezer’s temperature was registered at 73 degrees Fahrenheit while the refrigerator’s temperature was recorded at degrees Fahrenheit. Carbon monoxide detectors were observed. Smoke detectors are interconnected with the sprinkler system. Fire extinguisher was observed to be full and last serviced on 09/16/2025 First aid kit was complete. No issues noted during inspection. LPA observed that facility is ready to be licensed. This report will be submitted to the Centralized Application Bureau (CAB) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAB. Additional requirements may still be required. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Jan 26, 2026