Ivy Terrace at Garden Grove

Allegation investigated: Staff do not ensure medication is administered in a timely manner

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate an investigation into the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit. During the course of the investigation, LPA toured the facility and interviewed staff as well as reviewed and obtained pertinent documentation such as medication administration records. Regarding the allegation that staff do not ensure medication is administered in a timely manner, the investigation revealed the following: LPA reviewed resident medication administration records (MAR) for six residents. Per MAR, residents are receiving their medications as directed. Two out of two med techs confirm residents are receiving their medications as directed. During the visit, LPA toured the facility and observed five caregivers and one med tech working. Six out of six staff state working short at times due to call outs. Fully staffed is six caregivers and two med techs. All six staff interviewed confirm resident needs are being met at the facility. CONTINUED ON LIC 9099C DATED 05/22/2026 Unsubstantiated Based on interviews conducted and record review, LPA is unable to corroborate the allegation. Therefore, the allegations are deemed unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted and a copy of this report was provided to facility.the state’s words, verbatim · CDSS document, May 22, 2026 · control 22-AS-20260515133019

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Kimberly Lyman made an announced visit to conduct a pre-licensing inspection. LPA identified herself and discussed the purpose of the visit with Administrator Kyle Coleman. An initial application to operate a Residential Care Facility for the Elderly was submitted to Community Care Licensing on 05/09/2025 for a capacity of sixty eight non-ambulatory and four bedridden residents. Upon entry, facility appears clean, safe and sanitary. Facility has all required postings including personal rights, theft and loss policy, and the complaint poster. Administrator Kyle Coleman has an administrator certificate expiring on 09/26/2027. LPA Lyman along with Administrator Coleman toured the facility at 8:27 AM and observed the following: Structure: Facility is a one story building housing residents and a separate building for administrative offices. Living Room/ Dining Room: Adequate seating is available in the dining room and common areas. Bedrooms Residents: Rooms are single and double occupancy. All rooms are equipped with appropriate lighting, chair, night stand and ample closet space. Restrooms and bedrooms have fall monitoring technology. Linens & Hygiene Supplies: Facility has ample bedding and towels in supply as well as hygiene supplies. Bathrooms: All resident bathrooms have a working toilet/ wash basin. There are multiple common shower/ restrooms for residents. Emergency Phone Numbers and Exit Plan: Posted in the entrance of the facility. Food Service: LPA observed the kitchen and serving area. Facility has ample food and water in supply. LPA observed temperature logs are being utilized. Smoke Detectors: Smoke detectors and fire inspections are conducted quarterly by an outside company, Cal Building Systems. Facility tested fire system during the visit and alarms were operational as well as exit gate attached to alarm. Fire extinguishers are fully charged. Appliances: Kitchen and laundry appliances are operational. CONTINUED ON LIC 9099C DATED 11/20/2025 Toxins/ Sharps: Facility has secured areas for toxins and sharps. Water Temperature: Tested and recorded between 107.2 and 118 degrees F. in facility bathrooms. Emergency Supplies: LPA observed ample emergency food and water as well as emergency supplies. Medications, First-Aid Kit & Book: First aid kit observed contained all required items including tweezers, scissors and thermometer as well as a first aid manual. Medications are stored in locked medication carts. Facility uses an electronic medication administration record. Resident & Staff File: Records are to be stored in the medication room or business office. Reading Material, Games, and Equipment: LPA observed a posted activity schedule with activities such as games and exercise. Outside areas: LPA observed an outside area with ample shaded seating and a walking path. Fire Clearance: Approved for sixty eight non-ambulatory and four bedridden residents along with delayed egress on 06/25/2025. Facility has four rooms with specialized fire alarms for the hearing impaired. Component III conducted during the visit. Facility is ready to be licensed. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Nov 20, 2025