Ivy Park at Claremont.

Allegation: Staff did not follow proper eviction procedure It is alleged that the facility did not follow proper eviction procedures when issuing R1 a 30-day eviction notice. Based on record review and interviews conducted, it was determined that R1 is his own responsible party; therefore, the facility is not required to notify an additional responsible party regarding the eviction. Record review indicates that R1 signed the Resident Admission Agreement on 11/05/2021, acknowledging understanding of facility policies. Article II, “Responsibilities and Representation of the Resident,” specifies that the resident shall not engage in disruptive behavior, create unsafe conditions, or physically or verbally abuse other residents or staff. Documentation further reflects that the facility provided multiple written notices and letters of concern to R1 addressing behavioral issues and expectations prior to issuing the eviction notice. These documents demonstrate that R1 was informed of ongoing concerns and expectations for compliance with facility rules. Additionally, based on review of the eviction notice, it was determined that the notice is consistent with Title 22 requirements. Allegation: Staff do not serve residents food of good quality It is alleged that the facility does not provide residents with food of good quality, including concerns that meals may be improperly prepared or contain spoiled or moldy items. During staff interviews, all staff denied concerns regarding food quality, including any reports of spoiled or moldy food. Staff stated that meals are prepared in accordance with proper food handling procedures and that any concerns raised are addressed immediately. Staff further reported that the facility conducts regular meetings to discuss dining services and address resident feedback. Resident interviews were consistent, with the majority of residents reporting satisfaction with the food and denying any observations of mold or spoiled meals. Additionally, LPA toured the facility kitchen and observed proper food handling and storage practices. All food items appeared to be in good condition, with no visible signs of spoilage. Allegation: Staff Do Not Maintain Facility in Good Repair It is alleged that the facility is not being properly maintained in good repair, including concerns related to the elevator not functioning and other potential maintenance issues within the facility. During staff interviews, staff reported that the facility is maintained in good repair. Staff acknowledged that the elevator experienced a temporary malfunction in March 2026; however, repairs were completed as soon as the necessary part was obtained. Staff further reported that residents were notified of the repair status and were assisted as needed during the outage. Documentation reviewed indicates that Community Care Licensing (CCL) was notified of the elevator malfunction. Staff indicated that the elevator is maintained every six (6) months, and maintenance logs were provided and reviewed. Additionally, a recent fire alarm inspection was conducted with no issues identified, and copies of the inspection records were observed. LPA conducted a walkthrough of the facility and observed the elevator to be operational. The fire alarm system was not activated at the time of the visit, and no issues were observed. During interviews, R1 and other residents reported no current concerns regarding the fire alarm system. (continued on 9099C) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Allegation: Staff did not report incidents to appropriate parties It is alleged that the facility failed to report incidents involving R1’s behavior to appropriate parties, including failing to document and communicate concerns as required. During staff interviews, staff reported that incidents involving R1’s behavior were documented and maintained in the resident’s file. Staff stated that notes were completed following incidents and that, when necessary, witnesses were present during interactions due to R1’s communication style. Staff also reported that multiple letters of concern were issued to R1 addressing behavioral issues and expectations. Record review corroborated staff statements, as documentation including incident notes, letters of concern, and related records were observed in the resident’s file. Additionally, it was determined that R1 is his own responsible party. Based on the investigation conducted, which included interviews with staff and residents, as well as a review of relevant records, there was insufficient evidence to support the reported allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED . Exit interview was held, and a copy of this report was provided.

Allegation: Facility does not have hot water. It is alleged that the facility did not provide hot water at resident bathrooms and common area sinks, including the bathroom near the kitchen and the dining room sink, for several days. Staff consistently reported there was no complete loss of hot water at the facility. Staff reported temporary issues involving low water pressure and a required water shutoff on 2/11/2026 after approximately 8:00 p.m. to complete plumbing repairs, including replacement of a water pressure regulator and repair of a piping leak. Staff stated hot water remained available outside of the repair period, although pressure was reduced at times. Staff reported residents were notified of the temporary disruptions. Plumbing services were contacted and repairs were completed, as reflected in work orders and invoices reviewed by LPA dated 2/11/2026 and 2/17/2026. R1 reported experiencing a lack of hot water for several days, including the date of the investigation visit. R1 stated they were not notified of any water shutoffs and reported maintaining a log documenting days without hot water. During resident interviews R2–R7, Residents provided varied statements. Several residents denied experiencing issues with hot water or reported having continuous access to hot water. At the time of the visit, all residents interviewed confirmed that hot water was available. LPA verified hot water was accessible in resident rooms and common areas during the visit. During Witness One (W1) interview, W1 confirmed plumbing services were rendered at the facility and that repairs were conducted on 02/11/26 after approximately 8:00 p.m., once the kitchen was closed, in order to minimize disruption to residents in care. W1 stated that certain repairs may take several hours to complete and explained that during active plumbing repairs, water service must be shut off. W1 further stated that if a resident attempted to use water during the repair period, water may not have been available. W1 explained that for certain repairs, such as a piping rupture, initial work may be completed during daytime hours to patch the pipe, with follow-up visits occurring in the evening to complete full repairs, which require shutting off the water supply. During the facility walk through, LPA tested the dining area sink and observed hot water available. LPA documented the observation with a photograph and observed posted hand-washing guidelines. LPA toured the kitchen and observed hot water available, hand-washing signage posted throughout the kitchen, and hand sanitizer present at workstations. (continued on 9099C) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 LPA received Unusual Incident Reports related to both the pipe leak and the hot water pressure issue, which included notification of a temporary and slight water shutoff. LPA observed the bathroom near the dining area to be clean, with hot water accessible. LPA inspected a total of eleven (11) resident bedrooms, including R1’s room, and observed hot water available in each room, meeting regulatory temperature requirements between 105°F and 120°F. Some faucets required additional time to reach the required temperature; however, hot water was available. LPA reviewed work orders and invoices related to the water pressure regulator replacement and the piping leak repair, which reflected that the issues were addressed and corrected. Allegation: Staff did not observe personal hygiene and sanitation practices to maintain infection control. It is alleged that staff did not wash their hands using warm water and soap while performing duties. During resident R1 interview, R1 alleged that dining room staff (servers) did not consistently practice proper hand hygiene. R1 reported observing servers assist residents with walkers and then proceed to other duties without washing their hands. R1 further alleged that staff did not wash their hands using warm water and soap and stated that on the date observed, hot water was not available. During staff interviews, staff consistently reported they follow proper hand hygiene practices. Staff stated they wash their hands with soap and water, use gloves as required, and follow posted hand-washing guidelines. Kitchen and dining staff reported hands are typically washed in the kitchen area, where hand-washing supplies and signage are posted. Staff reported that hand hygiene is routinely practiced during resident care. During the facility walkthrough, LPA observed sufficient supplies of hand soap and hand sanitizer available in the kitchen, dining area, and common areas. Based on the investigation conducted, which included interviews with staff, witness, and residents, as well as a review of relevant records, there was insufficient evidence to support the reported allegations. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED . Exit interview was held, and a copy of this report was provided.

Licensing Program Analyst (LPA) Kimberly Ramirez and LPA Gabby Castro conducted an unannounced annual inspection visit and was greeted by Administrator Daisy Hernandez. LPA Ramirez explained the purpose of the visit. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: readily available to residents, were observed to be inaccessible to residents. LPA Ramirez observed carbon monoxide detectors and smoke alarms in hallways. LPA Ramirez inspected six (6) resident rooms. All resident bedrooms contained the required furniture, linens and lighting. Water temperatures in all grooming and bathing areas were measured to be with 105 – 120 degrees F. LPA Ramirez observed grab bars near toilets and inside shower. LPA Ramirez observed non-slip coating in showers. LPA Ramirez observed seated shower chairs in bathrooms. Food Service: LPA Ramirez observed a sufficient supply of nonperishables for one week and perishable foods for a minimum of two days in the facility kitchen area. Soaps, detergents, and cleaning compounds were observed to be stored away from food supplies. Freezers and refrigerators were observed to be clean and within temperatures of 0-degree F (-17.7 degree C), and refrigerators with maximum temperature of 40-degree F. (4 degree C). Planned Activities: LPA Ramirez observed board games, magazines, and other activities for residents. The facility employs a full-time activities director. See 809-C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Residents Rights-Information: LPA Ramirez observed the following postings in common areas throughout the facility: Complaint Poster (PUB 475), personal rights, and nondiscrimination notice. LPA Ramirez observed the facility land line. Disaster Preparedness: The facility has the Emergency Disaster Plan (LIC610D/9 pages) in place. The last documented emergency drills were conducted on 07/12/2025. LPA Ramirez observed facility sketches with exits and emergency exits routes throughout various locations of the facility. LPA Ramirez observed an emergency food supply. Residents with Special Needs : No large bodies of water were observed LPA Ramirez observed signs posted indicating “No smoking - Oxygen in Use” in various locations of the facility. LPA Ramirez observed several oxygen tanks in resident rooms secured in stands. Knives, sharps or other items that could pose a danger to residents with dementia, were observed to be inaccessible. Auditory devices were observed to be in working order. Health Related Services/Incidental Medical Services: The medications are centrally stored in the medication closet and in bubble packs and/or original containers. LPA Ramirez observed Centrally Stored Medication and Destruction Record. The facility provides incidental medical services. Staffing: Administrator Certificate for Daisy Hernandez 02/27/2027. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. Personnel Records Training: Staff files are maintained at the facility. LPA Ramirez observed the required annual training, CPR and First Aid for four (4) out of the four (4) personnel record reviewed. LPA Ramirez observed TB testing results, Health screening, fingerprint clearance and job application for four (4) out of the four (4) personnel record reviewed. Infection Control: Staff are using appropriate hand hygiene and wearing gloves while assisting clients. Staff are cleaning and disinfecting often for high touched surfaces. Facility has an Infection Control Plan in place. No deficiencies were observed during this visit. Exit interview conducted. A copy of this report was provided via email. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Operational Requirements: The fire clearance is approved for eighty-one (81) residents over the age of 59 years old, of which eight (8) may be bedridden on the 1 st floor only. This facility may retain no more than twenty (20) hospice residents. There were twelve (12) residents on hospice during the time of inspection. Resident Records/Incident Reports: LPA reviewed resident records for four (4) residents in care. Resident records are maintained at the facility. Admission Agreement, Physician's Report (including T.B and Ambulatory Status), Consent for Medical Treatment, Preplacement Appraisal Information, Resident Pre-Appraisal, Care Plan/Appraisal/Needs and Services Plan, Resident Rights were observed. See 809-C

The investigation revealed the following: regarding the allegation- “Facility staff do not provide adequate food service to residents.” It is alleged staff over salted food and did not provide quality food service to residents and their families on 04/19/2025. LPA Ramirez toured kitchen area and dinning room area during visit. LPA Ramirez observed facility walk in refrigerator temperature to read 40 degrees F, which is within regulation General Food Service Requirements- 87555(b)(21) . LPA Ramirez observed stored food in containers to contain labels that indicated “preparation date and use by date” on all containers with food. Food was stored away from chemicals and cleaning sinks. LPA Ramirez did not observe spoiled food while inspecting perishable foods and non-perishable foods. LPA Ramirez observed kitchen staff wearing hair nets and using gloves while handling food during today’s visit. Four (4) out of the four (4) staff interviewed did not corroborate this allegation. One (1) out of six (6) residents interviewed corroborated this allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED . No violations were observed during this investigation visit. Exit interview conducted. A copy of this report was provided via email.

The investigation revealed the following: regarding the allegation(s)- Facility staff are not properly addressing pest infestation in facility. It is alleged the facility has a mice and rodent infestation throughout the facility. Four (4) out of the four (4) staff interviewed did not corroborate this allegation. One (1) out of the five (5) residents interviewed corroborated this allegation. LPA inspected physical plant including kitchen, pantry, residents’ rooms, lobby, dining room, visitor bathrooms, memory care unit and outdoor patio. LPA did not observe any health and safety violations. LPA reviewed facility pest control contract services with Ecolab. According to pest control service contract reviewed, pest control services are performed monthly throughout the facility. LPA reviewed service report dated 3/11/25 (start time 9:38am- end time 10:56am), it revealed no rodent, no fly, no ant, and no cockroach activity was found during inspection. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED . Facility staff do not provide adequate food service to residents. It is alleged staff do not provide good quality food. Four (4) out of the four (4) staff interviewed did not corroborate this allegation. One (1) out of the five (5) residents interviewed corroborated this allegation. LPA inspected physical plant including kitchen, pantry, walk-in refrigerator, walk in freezers and dining room. LPA did not observe any health and safety violations. LPA observed kitchen staff wearing gloves while handling food and wearing hair nets. LPA observed perishable foods to contain labels that indicate discard date. LPA did not observe perishables to be spoiled or contain mold. Canned goods and dry foods stored in pantry contained labels that indicate discard dates. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED . Facility staff do not ensure that residents are delivered hot water throughout the facility. It is alleged facility staff do not maintain hot water temperatures in grooming areas, in the early morning hours. Four (4) out of the four (4) staff interviewed did not corroborate this allegation. One (1) out of the five (5) residents interviewed corroborated this allegation. LPA inspected random resident rooms to inspect, shared/visitor bathrooms throughout the facility and kitchen area. Water temperatures in grooming areas tested to be within 105 – 120 degree F. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED . No violations were observed or cited during this complaint investigation. Exit interview was conducted. A copy of this report was provided via email due to printer malfunction.