Ivy Park of Wellington.

Licensing Program Analyst (LPA) Ruth Martinez is conducting this unannounced visit for the purpose of completing an annual required inspection. LPA arrived at the facility and was greeted and granted entry by receptionist. LPA met with Brenda Myers, Interim Executive Director, and LPA explained the nature of the visit. Facility is licensed for 92 ambulatory, 120 non-ambulatory residents, of which 8 may be bedridden. Facility has an approved hospice waiver for 25 residents. Delayed egress doors for memory care only. There are 10 residents on hospice during today's visit. This facility consists of two main areas. The assisted living and the memory care unit which are protected by delayed egress exits. LPA Martinez along with the Interim Executive Director toured the physical plant of both the assisted living and the memory care unit. LPA observed a bistro adjacent to the main dining room where residents can obtain different snacks and beverages selections than in the main dining area. The bistro offers snacks all day so residents may dine when convenient. LPA observed menus and the food offered is varied and healthful. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Maintenance records were observed in the main kitchen. During the tour LPA observed residents involved in an activity as well as a posted activity schedule including games, exercise, and outings at the facility. LPA inspected that medication is centrally stored in a safe locked location; facility has 2 medication rooms on the memory care unit and on the 2 nd floor. LPA inspected both locations and LPA observed and inspected medication carts that are used to dispense meds to residents and observed medication was labeled and stored inaccessible to residents in care. Resident bedrooms had the required Continued on LC809-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 furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, and shower was free of mold/mildew. Several resident bathrooms on each floor were tested for water temperature and water temperature measured between 110.6 and 116.7 degrees F in tested bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. LPA pushed the restroom call button in various resident rooms and response times were under five minutes. LPA observed several residents who appeared clean, and happy. LPA observed that toxic chemicals, cleaning solutions and disinfectants are stored locked in a locked in housekeeping closet. LPA toured the memory care unit and observed a kitchen/ dining room as well as posted activity schedule for memory care residents. LPA observed residents in the memory care unit with care staff present. LPA tested the delayed egress exits/pull cord and response times were immediate. Carbon monoxide detectors tested and noted to be operational. Fire extinguishers are fully charged and had a service date of December 13, 2024. LPA observed several fire extinguishers mounted on the wall throughout the facility. Smoke detectors and sprinkler system are tested yearly by an outside agency, and LPA was provided with testing documentation, last testing was done April 22-23, 2025. Emergency drills are being conducted monthly on every shift with the last drill conducted on September 4, 2025. LPA observed stairwells have an emergency evacuation chair. Outside grounds have ample shaded seating for residents. LPA observed several courtyards with shaded seating areas for residents’ enjoyment. LPA observed a swimming pool which is under construction at the time of visit. LPA reviewed ten resident files and five staff files. All resident files contained required documentation including updated physician reports and care plans. Staff files contained required documentation including health screens, first aid, and fingerprint clearance. As a reminder LPA provided annual fee due information. Based on the observations made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with the facility representative, and a copy of this report was provided to the facility.

Inspection approved July 3, 2023, by Orange County Fire Authority approved/granted for 92 ambulatory, 120 nonambulatory and 8 bedridden residents. The Special conditions notated are as follows, bedridden approved for the following rooms: B107, B109, B111, B112, B113, D201, D202, and D203. Delayed egress doors for memory care ward only. Interview with facility Administrator stated that the facility has ambulatory and non-ambulatory residents on all floors of the facility considering that fire clearance has no restrictions on any floors. The only restrictions that the fire clearance has are the specific room for bedridden residents, to which the facility currently has no bedridden residents. We have found the complaint allegation is unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint. An exit interview was conducted with the Executive Director and a copy of this LIC9099 report was left at the facility.

CONTINUED FROM FORM LIC9099 During the present follow-up visit, LPA requested and obtained the facility's current resident census and requested records for six current memory care residents including their identification form, individual needs and services plan as well as charting notes. LPA reviewed the documentation added to the investigation file during the visit. Regarding the allegation that Facility is not following their Infection Control Plan , the following has been concluded: LPA was able to review the Infection Control Plan and related procedures in place during the initial complaint investigation visit. Staff interviews additionally detailed the specific measures utilized during a recent outbreak of upper respiratory infections that occurred in the facility's memory care in December 2024. Measures were listed as provision of Personal Protective Equipment for staff and residents, temporary isolation with meals provided in unit and regular checks by staff, surface cleaning in addition to weekly deep cleaning of bedrooms, emphasis on hand hygiene. Witness interviews with Orange County Public Health staff evidenced that the outbreak had been adequately reported on December 26, 2024. No concerns regarding the preventative measures implemented were stated during these interviews. Multiple staff interviews also indicated that appropriate antiviral treatment had been provided. Regarding the allegation that Facility did not provide the necessary cleaning services , the following has been concluded: Reported concerns appeared to indicate insufficient frequency of cleanings due to staff disruption during an outbreak occurring in December 2024. None of the staff members interviewed during the course of the investigation made statements corroborating that the facility was temporarily short-staffed. Multiple interviewees described a complimentary organization from caregiving and housekeeping staff in order to address both the recurring scheduled cleaning and spot clean-ups. Each visit conducted included a tour of the physical plant during which no evidence of insufficient cleaning was observed by licensing staff. Records reviewed however demonstrated that staff failed to document whether cleaning services had been provided for the second half of December 2024. CONTINUED ON FORM 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 CONTINUED FROM FORM LIC9099-C Regarding the allegation that Facility did not provide adequate medical care , a review of resident records as well as facility self-reporting documents demonstrated that resident R1 was hospitalized on December 24, 2024 and diagnosed with Influeza A after which a course of antiviral medication was provided. No failure to provide medical care as needed during the period leading up to the present investigation could be found. Earlier health concerns were addressed appropriately as demonstrated by earlier discharge documents dated May 2024. Additional records reviewed including charting notes for a random selection of six residents showed adequate flagging of health needs and appropriate responses being provided in a timely manner. As a result, the three allegations listed above are found to be Unsubstantiated, meaning that although the allegation 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 a facility representative.

This unannounced case management visit is being conducted by Licensing Program Analyst (LPA) Ruth Martinez to follow up on an incident reported to CCLD on February 05, 2025. LPA met with David Armour, Administrator/Executive Director and explained the purpose of today’s visit. Incidents was self reported on February 4, 2025 via incident report telephone call and LIC624 was received on February 05, 2025 regarding residents (R1) incidents of February 04, 2025. During today’s visit, LPA interviewed staff and obtained copies of pertinent documents. On February 04, 2025, at approximately 3:15am R1 left the premises via kitchen loading dock and headed towards the street. A civilian saw R1 and called 911 to report and paramedics were sent out. R1 was take to hospital for evaluation and has not returned to the community. Facility received a call from the hospital about 4:15AM informing them that R1 was at the hospital. R1 was discharged to a skilled nursing and facility staff is to re-assessed R1 prior to returning to the community. Once facility received call from the hospital informing them that R1 was there, facility staff called responsible party, Executive Director and LPA Martinez to informed them on the incident. This visit is being conducted for the purpose to review incident details and collect facility records. Facility has been in contact with hospital, skilled nursing and R1's DPOA for updated information. LPA did not observe any immediate and/or safety risks in or out of the facility. Based on the observations made during today’s visit, no deficiencies were noted today per Title 22 Division 6 of the California Code of Regulations . This report was reviewed with Executive Director and a copy of the report was provided and left at the facility.

Licensing Program Analysts (LPAs) Joseph Alejandre, Brandon Lopez, and Nancy Guillen made an unannounced visit to conduct the required annual inspection. LPAs were greeted and granted entry by staff. LPAs met with Executive Director David Armour and explained the reason for the visit. The facility is licensed for a capacity of 220 of which 120 can be non-ambulatory, approved for 8 bedridden and a hospice waiver for 25. Facility is one building with 4 stories. The building has a central courtyard with a pool which is fenced. LPAs and the Executive Director toured the facility. LPAs observed the fireplace in the lobby is screened. The See Something, Say Something Poster is posted in the mail room and is not in the main entry way of the facility. LPAs toured the kitchen and dining room. LPAs observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. LPAs observed the kitchen is clean and organized. LPAs observed the refrigerators and freezers are kept at the required temperatures. LPAs toured 11 resident rooms. LPAs toured rooms on each level. LPAs observed each stairwell has an emergency evacuation chair. LPAs observed all rooms had the required furnishings. LPAs observed in the rooms inspected that all the bathrooms are clean and operational. Hot water measures between 110.0 to 116.6 degrees Fahrenheit. Medications are kept locked in the med room in a locked medication cart. The memory care unit has their own med room and medication cart which is kept locked. LPAs and the Executive Director toured the memory care unit which is on the first level. The memory care unit uses a secured perimeter and has delayed egress exits. LPAs tested 4 delayed egress exits and all exits operated properly. No obstacles or hazards observed in the memory care unit. The facility has activity rooms and sitting areas on each floor. There is an outdoor patio on the first level which has a pool. The pool fence is 5 feet tall and kept locked and is inaccessible to residents. LPAs observed the facility has emergency food and water stored in a storage room. No obstacles or hazards observed in the patio. There is shaded seating in the patio. No obstacles or hazards observed in the facility. LPAs reviewed resident medications and files. LPAs reviewed 11 resident files, no discrepancies observed. LPAs reviewed 10 staff files, no discrepancies observed. Staff had the required training and is associated to the facility. The last emergency drill took place on October 17, 2024. The fire suppression was tested on April 26, 2024. The facility is operating within their license. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.

Licensing Program Analyst (LPA) Dwayne Mason Jr. arrived at the facility to conduct and unannounced Case Management Incident Follow Up. LPA entered the facility and was greeted by Robin Colton in Reception. LPA stated the purpose of the inspection. Colton brought LPA to Interim Executive Director (IED) Kathleen Olson's office. LPA stated they are following up on the Unusual Incident Reports submitted to CCL on 1/24/24 regarding both spouses in a married couple. LPA obtained copies of the Admission Agreements, Resident Information Form and Resident Ledger pertaining to the couple. IED also provided LPA with a written list indicating each day the couple visited the facility for a meal. IED pulled these dates from Dining Room Meal Logs. LPA also obtained from the facility staff the Case Number, Detective name and Police station associated with the incident. Additionally, LPA obtained a photo of the Coroner's Seal affixed to the couple's private residence. Based on Record Review LPA determined the couple had been paying to rent a room at the facility since August 31, 2023. Based on interview with the IED, the residents paid to rent the room, visited the facility but resided at a private residence away from the facility. LPA conducted a health and safety check and noted two panels missing from the ceiling tiles. IED stated the removed tiles sustained water damage during recent rain and were removed so they could dry. IED stated service has been scheduled to repair ceiling tiles. IED stated that when the couple moved in, they only moved in a few pieces of furniture and stated they would not be residing in the room and did not want to receive service. LPA toured the couple's room and noted a bed in each room, two wooden chairs in the living room and a wooden table in the living room. LPA observed no personal items, food or entertainment devices in the facility apartment. LPA obtained photos of the room. (Continued on LIC809C) 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 Based on Record review, the couple came to the facility 21 times for meals in September, 14 times for meals in October, 5 times in November and 1 day in December. The couple was last at the facility on December 4, 2023 for a meal. On December 18, 2023 Jessica Bacca, Senior Sales Manager, began calling the couple to find out their whereabouts. After being unable to get a hold of the couple via phone, the facility began calling the emergency contact listed on the Resident Information Form for the couple. The facility was unable to get a hold of the emergency contact. Iberia Tarin, Business Office Director called the couple on January 3, 2024 following a declined payment. LPA verified via Record Review the facility froze the couple's account on January 4, 2024. On January 16, 2024, Bacca conducted a wellness check at the couple's private residence due to concerns surrounding their well being. Upon arrival, Bacca observed and photographed the Coroner's seal affixed to the door of the couple's private residence. Licensing Program Analyst conducted an exit interview with Interim Executive Director Kathleen Olson and a copy of this report was provided.

Licensing Program Analyst (LPA) Sean Haddad conducted this announced inspection for the purpose of conducting a pre-licensing inspection. LPA met with Applicant (AP) Monica Castilo, discussed the purpose of the inspection, and toured the facility. Facility is to operate a Residential Care Facility for the Elderly. Application was submitted to Community Care Licensing on 08/01/2022. This is a change of ownership with persons in care. During the inspection, LPA and AP observed the following: Structure: facility is a large commercial facility. There is one building with four stories. The memory care unit is on the first floor with delayed egress and has its own common areas, dining room, and two outdoor patios. The rest of the building is for assisted living. The assisted living kitchen and dining room are on the second floor. There are two outdoor courtyards for assisted living residents on the first floor. There is a dedicated medication room for the memory care unit and also one for the assisted living section. There are 21 bedrooms in the memory care unit and 155 bedrooms in the assisted living section, with each bedroom having its own bathroom. There are also common bathrooms, activity rooms, and common areas throughout the facility. Facility telephone number is (949) 586-3393. Resident Bedrooms: the resident bedrooms are spacious and will easily accommodate the residents’ furnishings. Lights, chairs, linens, and storage for 12 resident bedrooms inspected. Bathrooms: were clean, faucets and toilets were operational. Water temperature: tested between 114 degrees F and 118.9 degrees between the 12 resident bathroom faucets tested. Linens & Hygiene Supplies: new linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan & Menu: reviewed. Food Service: 2 days perishable and 7 days nonperishable food supply reviewed. Carbon Monoxide, Smoke Detectors, Fire Extinguisher: observed. Appliances: stove burners, microwave, washer, and dryer inspected. Knives: observed locked in the kitchen. Toxins: observed locked in the first floor housekeeping room. Medications are locked in medication carts inside the two medication rooms. First-Aid Kit & Activity Supplies: observed and available. 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 Resident & Staff Files: LPA reviewed 5 resident files and 5 staff files. Fire clearance was approved by Orange County Fire Authority on 07/02/2023. Courtyard exit gates are operational and unlocked. Courtyards have shaded area for outdoor activities and sufficient seating for residents. Component III was completed with AP during today’s inspection. Facility is currently operating under the liability insurance of current facility LAS PALMAS (306005349). AP will switch liability insurance to new facility once the application is approved. During the inspection, LPA explained the process of this application and about the post licensing inspection once the facility is licensed. AP was informed today that the facility is ready for licensure and final approval will be processed by the CAB supervisor in Sacramento. An exit interview was conducted and a copy of this report was discussed with and provided to AP.