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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 435202744
Report Date: 09/23/2026
Date Signed: 09/23/2026 05:03:02 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/19/2026 and conducted by Evaluator Manuel Monter
COMPLAINT CONTROL NUMBER: 26-AS-20260719105437
FACILITY NAME:IVY PARK AT MILPITASFACILITY NUMBER:
435202744
ADMINISTRATOR:MEGHIAN GEULFACILITY TYPE:
740
ADDRESS:80 CEDAR WAYTELEPHONE:
(408) 770-9575
CITY:MILPITASSTATE: CAZIP CODE:
95035
CAPACITY:225CENSUS: 223DATE:
09/23/2026
UNANNOUNCEDTIME BEGAN:
03:55 PM
MET WITH:Interim Administrator Kellie ShearerTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Staff did not respond to a residents call for assitance/ pendant in a timely manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced complaint inspection to deliver the findings on the above allegation. LPA met with Interim Administrator Kellie Shearer

On July 19, 2026, the Department received a complaint alleging Staff did not respond to a residents call for assistance/ pendant in a timely manner.

On July 20 and 23, 2026, Licensing Program Analyst Manuel Monter interviewed Residents R1-R12. R1 stated he/she is dissatisfied with the facility’s response time. R1 reported that on July 17, 2026, at about 1:00am, he/she transferred from bed to the wheelchair to use the restroom but fell while attempting to transfer to the toilet. R1 pulled the emergency cord, and staff arrived around 1:15–1:20am. R1 stated the staff member could not assist him/her alone and requested a second caregiver. R1 stated 911 was contacted and emergency services assisted him/her up to bed. R1 stated 911 was contacted around 2:00am. R1 stated emergency services arrived around 2:15am and put him/her on his/her bed.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2026
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 4
Control Number 26-AS-20260719105437
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: IVY PARK AT MILPITAS
FACILITY NUMBER: 435202744
VISIT DATE: 09/23/2026
NARRATIVE
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R1 stated that around 3:00am his/her knee was bothering him/her, causing slight discomfort. R1 stated he called the front desk at about 3:00am, but no one answered, so he/she left a voicemail. R1 stated that around 4:00am he/she called again and reached a caregiver, who said staff were very busy but would send someone. R1 stated that no one arrived and that he/she remained awake from 3:00am to 9:00am. R1 also did note that some calls to the front desk did not connect due to poor cellular reception in the building.

R1 stated he/she then called the front desk at 8am and spoke S5. R1 stated the front desk staff stated a care giver would be sent to R1’s room. R1 stated by 9:00am, no staff had come to assist him/her. R1 stated he/she then contacted 911 and they took R1 to Kaiser Emergency Room in Santa Clara.

R2 stated he/she uses his/her pendant when he/she needs assistance from staff. R2 stated staff response time can range from 15 minutes to 30 minutes. R6 stated he/she does remember a time when staff responded to his/her pendant assistance request was over an hour but does not recall the details of that day. R12 stated he/she has not needed to use his/her pendant and is not aware of staff response times.

8 Out of 12 Residents interviewed (R3-R5, R7-R11) stated he/she uses his/her pendant when he/she needs assistance from staff and has not had any issues with the staff’s response time to their pendant requests for assistance.

On July 23, 2026, Licensing Program Analyst Manuel Monter interviewed Staff S1-S2. S1 stated that when residents use the call button, staff are expected to respond within 15 minutes. S1 stated there have been instances when residents waited longer than 15 minutes. S2 stated due to staffing levels, it can be very difficult to respond to residents pendant calls for assistance timely. S2 stated there will be instances where call button activations will be responded to in some instances, 30 minutes.

On August 6, 2026, Licensing Program Analyst Manuel Monter interviewed staff S3-S8. 5 Out of 6 staff interviewed (S3, S4, S6- S8) stated facility staff should respond to pendants / calls for assistance within 15 minutes. 3 Out of 6 staff interviewed ( S4, S7, S8) stated there have been instances where facility response time can be over 30 minutes.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 26-AS-20260719105437
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: IVY PARK AT MILPITAS
FACILITY NUMBER: 435202744
VISIT DATE: 09/23/2026
NARRATIVE
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S5 stated he/she recalls receiving a call from R1 around 9:00am on July 17, 2026. R1 had called telling S5 he/she called 911 because he/she needed assistance. S5 stated he/she had then paged the care team to go to R1’s room. S5 stated moments later emergency services arrived and took R1 to the hospital.

On August 6, 2026, Licensing Program Analyst Manuel Monter interviewed Administrator (ADM) Meghian Geul. ADM stated the facility doesn’t have a set time staff need to respond to pendant calls. ADM stated facility staff should respond within 15-20 minutes but reiterated that they do not have a policy or a set time that staff need to respond.

On August 26, 2026, Licensing Program Analyst Manuel Monter interviewed staff S9 -S14. S9 confirmed he/she worked on July 16–17, 2026. S9 stated he/she responded to R1’s emergency pull cord between 11:00pm–12:00am and found R1 sitting on the bathroom floor. After cleaning, S9 attempted to help R1 up but was unable to do so alone. S9 stated that after several attempts, he/she called S15 for assistance, and S15 arrived within 10 minutes. Both staff members tried to assist R1 but were still unable to get him/her up. S9 stated R1 then requested that 911 be called to assist and evaluate him/her. S9 reported R1 did not express pain, show signs of bleeding or bruising, and denied hitting his/her head.

S9 stated that paramedics arrived within 20 minutes, and three paramedics assisted R1 back into bed. S9 stated that paramedics assessed R1, who stated he/she was fine and not in pain. S9 noted that R1 was joking with the paramedics and did not appear to be in distress. S9 stated that once the paramedics finished, they continued with their duties. S9 also stated that no further emergency, phone calls or pendant calls from R1 the remainder of his/her shift.

5 Out of 6 staff interviewed (S9-S13) stated facility staff should respond to pendants / calls for assistance within 15 minutes. 6 Out of 6 staff interviewed (S9-S14) stated there have been instances where facility response time can be over 30 minutes.

On September 9, 2026, Licensing Program Analyst Manuel Monter interviewed staff S15. S15 stated he/she recalls the incident involving R1 during the NOC shift of July 16–17, 2026. S15 reported that around 12:15am, R1 pulled the bathroom emergency cord and S9 responded but was unable to assist R1 up, so S9 contacted S15. S15 stated he/she arrived at R1’s room within 5 minutes, and both he/she and S9 attempted to help R1 up but were unsuccessful.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 26-AS-20260719105437
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME: IVY PARK AT MILPITAS
FACILITY NUMBER: 435202744
VISIT DATE: 09/23/2026
NARRATIVE
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 S15 stated R1 became frustrated and requested that 911 be called to assist and assess him/her. S15 reported that R1 denied hitting his/her head and was not expressing pain at the time. S15 stated paramedics arrived approximately 7–8 minutes later. S15 stated that when paramedics arrived, they assisted R1 back into bed. S15 reported the paramedics asked R1 what happened, and R1 explained he/she had gone to the bathroom and fallen. R1 stated he/she was not in pain and did not hit his/her head. S15 stated the paramedics assessed R1 and, after confirming no injuries, concluded their visit.

S15 stated he/she received a call from R1 between 5:00am–6:00am on the medtech phone. R1 requested a caregiver to help locate documents in preparation for going to the hospital. S15 stated R1 did not report pain or request immediate assistance. S15 informed R1 that he/she and the caregiver were busy but would send someone when available. S15 stated that before clocking out, he/she informed the AM shift that R1 needed help finding paperwork in his/her apartment for the hospital.

The Department reviewed R1’s Pendant Response activity report. On June 17, 2026, at 12:12am R1’s pendant was activated and was cleared at 12:16am.

The Department reviewed R1’s Progress Notes. Progress Note Dated July 16, 2026, 11:30pm, R1 was trying to transfer him/herself to toilet from wheelchair. R1 slipped and went on the floor. Medtech and care giver tried to assist R1 up from floor. R1 insisted on calling 911.

Progress Note dated July 17, 2026, at 10:40am, R1 called 911 and sent him/herself to the hospital. Facility contacted Kaiser Santa Clara to follow up, who stated no fractures noted and everything was normal and R1 would be discharged the same day.

The Department reviewed R1’s Service Plan dated May 26, 2026. Under toileting needs, the service plan states R1 requires no assistance in toileting needs. Under Transfer, R1 requires physical assistance- care giver (1) will provide physical assistance with transfers.

Based on investigation, records reviewed, and interviews conducted, the Department found that the above allegations are UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegations did or did not occur
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Manuel Monter
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4