Ivy Park at Fullerton.

On November 4, 2025, at 8:00 AM, Licensing Program Analyst (LPA) Edward Kim conducted an unannounced required 1-Year annual visit using the CARE Inspection Tool. Upon arrival at the facility, LPA Kim was greeted and met with Interim Executive Director (ED) Sam de Guzman. The facility is licensed to operate for eighty-five (85) nonambulatory residents of which eight (8) may be bedridden and have a hospice waiver for twenty (20) residents. The facility is a two-story structure and consists of the following: sixty-three (63) resident bedrooms, six (6) offices, sixty-eight (68) bathrooms, living area, two dining areas, beauty salon, TV room, kitchen, bistro, two activity rooms, theater room, lounge, parking garage, and outdoor seating area. LPA Kim toured inside and outside of the physical plant. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for each resident’s personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. The Resident’s rooms were inspected: Resident Room 112, Resident Room 125, Resident Room 153, Resident Room 201, Resident Room 216, Resident Room 229, Resident Room 231, Resident Room 240, and Resident Room 255. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured 115.3 degrees F to 117.5 degrees F. A comfortable temperature of 73 degrees F was maintained in the facility. Evaluation Report Continues on LIC 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 LPA Kim observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is a two-day supply of perishable and seven-day supply of non-perishable food available and maintained properly. Emergency food, emergency water, and emergency supplies were stored in the parking garage. The facility has fourteen (14) fire extinguishers that were charged, mounted throughout the facility, and serviced on October 29, 2025. During the visit, LPA Kim observed the facility's infection control practices, plan of operation, and screening protocols for visitors, staff, and residents. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The smoke detectors and carbon monoxide detectors were inspected by CAL Building systems on December 6, 2024. Sprinkler system was inspected and tested by Cal Building Systems on December 6, 2024. A working telephone (714-738-3656) and internet capable devices for teleconferencing purposes remain available. Emergency drill logs were last conducted on October 23, 2025, and are conducted monthly. LPA observed the facility had current Evidence of Liability Insurance effective May 1, 2025, to May 1, 2026. LPA Kim conducted an audit of eight (8) resident files (R1-R8), six (6) staff files (S1-S6), and medication and medication administration record. LPA observed R1’s diagnosed with dementia with a physician’s report dated October 11, 2024, and R2’s diagnosed with dementia with a physician’s report dated November 2, 2024. LPA Kim conducted interviews with six (6) staff and five (5) residents. A Technical Violation was assessed during the visit in regard to R1 being diagnosed with dementia with a medical assessment dated October 11, 2024, and R2 being diagnosed with dementia with a medical assessment dated November 2, 2024. An exit interview was conducted, LIC811, LIC9102, and a copy of this report was provided to Interim Executive Director Sam De Guzman.

Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. made an announced visit to the facility for purpose of conducting a pre-licensing inspection. LPA met with Business Office Director (BOD) Cherie Harris. Administrator (AD) Christina Hale arrived shortly after. An application for Change of Ownership (CHOW) to operate a Residential Care Facility for the Elderly (RCFE) was submitted to Community Care Licensing (CCL) on November 13, 2023. The facility is to have a capacity of 85, of which 77 can be nonambulatory and eight bedridden. Facility phone number 714-738-3656. LPA observed the following. Structure: The facility is a two-story structure and consists of the following: 65 resident bedrooms, six offices, living room area, dining room, private dining room, two activity studios, salon, theater room, kitchen, bistro, lounge parking garage, and outdoor seating area. LPA observed the See Something, Say Something poster (PUB 475) in the facility mounted on the wall in the entranceway. There is an enclosed courtyard and a sensory room in the memory care unit. LPA did not observe any obstacles or hazards in the courtyard and/or hallways. Resident Bedrooms All resident bedrooms had the required furnishings. LPA observed all beds had linens and blankets. Signal system Signal system was tested and observed to be operable. CONTINUED ON LIC9099-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 Toxins: All and any toxic chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to residents and will be stored and locked in the various storage rooms. Medications, First-Aid Kit & Book: Medication is stored in a locked staff office in a locked medicine cart. First aid kit is stored in the medication room. The first aid kit has all the required elements. Resident & Staff Files : Records will be kept locked in a staff office. Pool/Jacuzzi: No bodies of water were observed. Fire Extinguisher: A fire extinguisher is located in every hallway and in the kitchen of the facility. Fire extinguishers were fully charged with service tags dated October 17, 2024. Reading Material, Games, Equipment & Materials: The facility has reading books, arts and crafts supplies, board games, puzzles, and other recreational materials for resident use stored in the activity room. Bedrooms Staff: There is no staff bedroom. Bathrooms: All bathrooms have working plumbing. Hot water measured between 107.6 and 112.2 degrees Fahrenheit. Linens & Hygiene Supplies: A supply of extra linen was stored in the laundry rooms. 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 Emergency Phone Numbers, Exit Plan & Menu: Posted and available for review, an emergency disaster plan with means of exiting and emergency phone numbers listed. Menu was also posted and available. Food Service: A supply of 2-day perishable and 7-day of non-perishable food was observed and will be maintained on hand. Smoke Detectors: Carbon monoxide detectors tested operational. Fire alarm was tested on April 30, 2024 by Johnson Controls. Appliances: Gas burner stove, refrigerators, walk-in freezer, microwave, washers, and dryers were inspected and observed to be operational. Fire clearance: Fire Clearance approved by a fire inspector of Fullerton Fire Department on May 16, 2024. Special conditions noted, "No restraints. No smoking in rooms utilizing air induced mattresses. Temporally bedridden provide the Fullerton Fire Department with notification within 48 hours of resident's admission or retention in the facility." Component III: Conducted at the Pre-Licensing visit, information provided about how to operate the facility within compliance and reporting requirements. LPA advised Applicant to use the general email address: CCLASCPOrangeCountyRO@dss.ca.gov for inquiries and to submit incident reports. The applicant has met all pre-licensing requirements. LPA will submit notification to CAB (Centralized Application Bureau) in Sacramento for final review prior to license being issued. Applicant was informed today that the final approval will be processed by CAB in Sacramento. Exit interview was conducted and a copy of this report was left with the applicant.