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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320431
Report Date: 09/18/2026
Date Signed: 09/18/2026 04:28:21 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/10/2026 and conducted by Evaluator Socorro Leandro
COMPLAINT CONTROL NUMBER: 11-AS-20260310143052
FACILITY NAME:IVY PARK AT PALOS VERDESFACILITY NUMBER:
198320431
ADMINISTRATOR:JOE SALDANAFACILITY TYPE:
740
ADDRESS:25535 HAWTHORNE BLVD.TELEPHONE:
(310) 377-7425
CITY:TORRANCESTATE: CAZIP CODE:
90505
CAPACITY:115CENSUS: 84DATE:
09/18/2026
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Executive Director - Brenda MyersTIME COMPLETED:
04:40 PM
ALLEGATION(S):
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Staff are mismanaging residents medication
INVESTIGATION FINDINGS:
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On 09/18/2026, Licensing Program Analyst (LPA) Socorro Leandro conducted an unannounced complaint investigation visit regarding the allegation listed above. LPA met with the Executive Director, Brenda Myers and the purpose of the visit was explained. LPA was granted entry to the facility.

Investigation consisted of the following:

On 03/11/2026, records were gathered. On 09/18/2026, medications were reviewed alongside Medication Administration Records (MARs).
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 7
Control Number 11-AS-20260310143052
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: IVY PARK AT PALOS VERDES
FACILITY NUMBER: 198320431
VISIT DATE: 09/18/2026
NARRATIVE
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Investigation revealed the following:

Allegation: “Staff are mismanaging residents’ medication.”

On 09/18/2026, Resident 2’s (R2) and Resident 3’s (R3) medications were reviewed alongside their Medication Administration Records (MARs); facility staff assisted with medication review.

Residents 2's Medication Review

Routine medication: Hydralazine 50 mg tab – On 09/05/2026 at 7:00 PM, there is no staff initial nor note on the MAR.

Routine medication: Memantine 10 mg tab – On 09/16/2026 and 09/17/2026 at 5:00 PM, there is a staff initial stating that the medication was provided to R2 on the MAR. The medication bubble pack came with a total of 30 tablets; the first tablet was popped on 09/16/2026; there are a total of 29 tablets in the bubble pack. Thus, there should have been a total of 28 tablets in the bubble pack.

Routine medication: Oyster Calcium Element 500 mg tab - On 09/17/2026 at 5:00 PM, there is a staff initial stating that the medication was provided to R2 on the MAR. The medication bubble pack came with a total of 30 tablets; the first tablet was popped on around 08/27/2026; there are a total of 9 tablets in the bubble pack. Thus, there should have been a total of 8 tablets in the bubble pack.

Routine medication: Preservision Ared 2 Cap for 5:00 PM – On 09/17/2026, there is a staff initial stating that the medication was provided to R2 on the MAR. The medication bubble pack came with a total of 30 tablets; the first tablet was popped on around 09/06/2026; there are a total of 18 tablets in the bubble pack. Thus, there should have been a total of 17 tablets in the bubble pack.

Routine medication: Quetiapine 25 mg tab – take 1.5 tablets every day at 5:00 PM – MAR demonstrates that medication was provided from 09/01/2026 to 09/17/2026. There are two bubble packs; one bubble pack has whole tablets, and the other bubble pack has half tablets, bubble packs came with a quantity of 30 tablets. The bubble pack with whole tablets was first popped around 08/21/206; there are a total of 3 tablets remaining in the bubble pack. Thus, there should have been 2 tablets remaining in the bubble pack.

Routine medication: Risperidone 1mg tab – MAR states that medication was provided on 09/08/2026 and 09/16/2026 at 1:00 PM. Bubble Pack for 1:00 PM states that the first bubble was popped on 09/06/2026. There are a total of 20 tablets remaining in the bubble pack. Thus, there should have been 18 tablets remaining in the bubble pack.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 11-AS-20260310143052
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: IVY PARK AT PALOS VERDES
FACILITY NUMBER: 198320431
VISIT DATE: 09/18/2026
NARRATIVE
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Resident 3's Medication Review

Routine medication: Nystatin 1000,000Unit/GM Powder – On 09/05/2026 at 8:00 PM, there is no staff initial nor note on the MAR.

Routine medication: Senna 8.6 mg tab - On 09/05/2026 at 7:00 PM, there is no staff initial nor note on the MAR. The bubble pack came with a quantity of 30 tablets; the bubble pack was first popped around 08/26/2026. The bubble pack has a total of 8 pills remaining. Thus, one extra pill is in the bubble pack.

Prescription Nonprescription Medication (PRN): CP ABHR 10 mg gel – Medication was not found by staff.

Substantiated: Based on observations, interviews and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D.

An exit interview was conducted with Executive Director, Brenda Myers, and a copy of this report and the appeals rights was provided.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 11-AS-20260310143052
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: IVY PARK AT PALOS VERDES
FACILITY NUMBER: 198320431
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/18/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/19/2026
Section Cited
CCR
87465(a)(4)
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Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-
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The Executive Director has agreed to create a plan to maintain medications and medication records in compliance and email said plan to Socorro.Leandro@dss.ca.gov
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administered medications as needed.

This requirement was not met as evidence by:

Based on record review, observations, and interviews, R2 and R3 had medication errors.
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The faciltiy is currently enrolled in the Departments Technical Support Program for medication.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/10/2026 and conducted by Evaluator Socorro Leandro
COMPLAINT CONTROL NUMBER: 11-AS-20260310143052

FACILITY NAME:IVY PARK AT PALOS VERDESFACILITY NUMBER:
198320431
ADMINISTRATOR:JOE SALDANAFACILITY TYPE:
740
ADDRESS:25535 HAWTHORNE BLVD.TELEPHONE:
(310) 377-7425
CITY:TORRANCESTATE:CAZIP CODE:
90505
CAPACITY:115CENSUS: 84DATE:
09/18/2026
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Executive Director - Brenda MyersTIME COMPLETED:
04:40 PM
ALLEGATION(S):
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2
3
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5
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Questionable death
INVESTIGATION FINDINGS:
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On 09/18/2026, Licensing Program Analyst (LPA) Socorro Leandro conducted an unannounced complaint investigation visit regarding the allegation listed above. LPA met with the Executive Director, Brenda Myers and the purpose of the visit was explained. LPA was granted entry to the facility.

Investigation consisted of the following:

On 03/11/2026, records were gathered. On 09/18/2026, Resident 1 ‘s (R1) records were reviewed.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 11-AS-20260310143052
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: IVY PARK AT PALOS VERDES
FACILITY NUMBER: 198320431
VISIT DATE: 09/18/2026
NARRATIVE
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Investigation revealed the following:

Allegation: “Questionable death”, it is being alleged that R1 passed away in the facility due to staff neglect. R1’s records reviewed revealed the following: Preplacement Appraisal Information dated 12/11/2024 stated that R1 was recently diagnosed with severe “aortic stenosis” and has taken a “sharp decline.” UCLA Medical Records dated 12/15/2024 indicated that R1’s past diagnosis are as follows high cholesterol, hypertension, dementia, cancer, etc. R1 was under Heartford Hospice care from 08/04/2025 to 08/20/2025 due to a terminal diagnosis of “Athscl heart disease of native coronary artery w/o ang pctrs.” Medication Administration Records (MARs) reviewed from May 2025 to August 2025 did not show medication errors. Death Report dated 08/21/2025 indicated that R1 passed away on 08/20/2025 due to “Athscl Heart Disease of Native Coronary Artery w/o Ang Pctrs-years.” Unsubstantiated: 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.

An exit interview was conducted and a copy of this report was left with the Executive Director, Brenda Myers.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2026
LIC9099 (FAS) - (06/04)
Page: 6 of 7