435202847-8-23-2026-26-AS-RMAO-DXY2L5-20260915172859

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202847
Report Date: 08/07/2026
Date Signed: 08/23/2026 07:46:24 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
04/09/2026 and conducted by Evaluator Maria Partoza

COMPLAINT CONTROL NUMBER: 26-AS-20260409145843

FACILITY NAME:	IVY PARK AT SAN JOSE		FACILITY NUMBER:	435202847
ADMINISTRATOR:	BALDUGO, VALERIE		FACILITY TYPE:	740
ADDRESS:	4855 SAN FELIPE ROAD		TELEPHONE:	(408) 223-1312
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95135
CAPACITY:	140	CENSUS:	DATE:	08/07/2026
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Frank LIm - Business Office Director		TIME COMPLETED:	10:15 AM

ALLEGATION(S):

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Staff are not ensuring residents’ personal hygiene needs are met.
Staff are not maintaining the facility in safe, sanitary condition

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced complaint investigation visit to deliver the findings of the complaint received by the Department. LPA met with Business Office Director (BOD) Frank Lim and the manager in charge for the day. LPA stated the purpose of the visit. Executive Director/Administrtor Karina Nevarez was not available due to prior commitment.

On 04/09/2026, the Department received a complint with the above allegations. On 04/10/2026, LPA Partoza conducted an initial investigation visit and subsequent visits were conducted on 04/29/2026, 05/05/2026, and 06/05/2026 to conduct interviews, inspect the Memory Care unit, gather information, and review resident records.

See LIC 9099C for continuation
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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 26-AS-20260409145843

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 SAN JOSE	FACILITY NUMBER: 435202847
	VISIT DATE: 08/07/2026

NARRATIVE

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Staff are not ensuring residents’ personal hygiene needs are met.

On 04/10/2026 and 04/13/2026, LPA Partoza interviewed the Reporting Party (RP). RP stated residents in the Memory Care unit were observed wearing soiled clothing and exhibiting poor hygiene. RP stated resident laundry was not being completed and R1 was observed wearing soiled clothing and using bedding that appeared soiled. RP also reported concerns regarding R1’s oral hygiene and stated R1 developed multiple cavities since the previous dental visit. RP further expressed concern regarding R1’s history of urinary tract infections.

On 04/10/2026, 05/05/2026, and 06/05/2026, LPA Partoza interviewed eight staff (S1, S2, S3, S4, S5, S6, S7, and S8). S1, S5, S6, S7, and S8 stated residents receive assistance with personal hygiene based on assessed needs, and clothing and bed linens are changed when soiled. S6, S7, and S8 stated R1 requires prompting with personal hygiene and that R1's clothing and bedding may become soiled due to food related behaviors. S2, S3, and S4 stated resident laundry is completed on a scheduled basis and additional laundry is completed as needed.

On 04/10/2026, LPA Partoza attempted to interview R1; however, R1 responded in a language not familiar to LPA and did not provide information relevant to the allegation. LPA observed R1’s laundry basket was not overflowing and did not observe visible soiling on clothing stored in the closet. On 04/29/2026, LPA Partoza interviewed R2 and attempted to interview R3. R2 was unable to provide information regarding personal hygiene or laundry practices, and R3 was unable to provide information relevant to the allegation. On 05/05/2026, LPA Partoza interviewed R4. R4 acknowledged that the bathroom sink was clogged and stated “ok” when asked how R4 was doing and about staff.

On 04/10/2026, LPA Partoza reviewed information received from RP, including email communications and photographs, R1’s Resident Assessment, and Individualized Service Plan (ISP). The records documented that R1 requires assistance with grooming, bathing, dressing, and toileting, and supervision and prompting due to memory impairment. The ISP also documented assistance with clothing and linen needs.

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SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2026

LIC9099 (FAS) - (06/04)

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Control Number 26-AS-20260409145843

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 SAN JOSE	FACILITY NUMBER: 435202847
	VISIT DATE: 08/07/2026

NARRATIVE

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On 04/10/2026, 04/29/2026, and 06/05/2026, LPA Partoza inspected resident rooms in the Memory Care unit, including rooms occupied by R1, R2, R3, and R4. LPA observed laundry baskets were not overflowing. Clothing worn by residents and clothing stored in resident closets had no visible staining or food residue. LPA did not observe visible soiling on the bed linens inspected.

Based on interviews, inspections, and records reviewed, R1 requires assistance and prompting with personal hygiene. 5 Out of 8, staff stated residents receive assistance with personal hygiene and that clothing and bed linens are changed when soiled. During three inspections, LPA did not observe visible soiling on resident clothing or bed linens or overflowing laundry baskets.

Staff are not maintaining the facility in safe, sanitary condition.

On 04/10/2026 and 04/13/2026, LPA Partoza interviewed the Reporting Party (RP). RP stated the Memory Care common bathroom had an empty soap dispenser, sticky flooring, fecal residue on the toilet, and insufficient restroom supplies. RP also stated the kitchen sink soap dispenser was empty and housekeeping tasks were not being completed. RP provided photographs of the reported conditions.

On 04/10/2026, 04/29/2026, and 06/05/2026, LPA Partoza inspected the Memory Care unit, including the common bathroom and resident rooms. LPA observed hand soap, toilet paper, paper towels, and toilet seat covers available in the common bathroom. LPA did not observe visible fecal residue on the toilet, sticky flooring, overflowing trash receptacles, or visible accumulation of debris during the inspections. On 04/29/2026, LPA also observed one resident bathroom sink draining slowly. Facility staff contacted S4, who responded to the concern, and LPA later observed the sink draining after the clog was cleared.

On 04/29/2026 and 05/05/2026, LPA Partoza attempted to obtain information from Memory Care residents regarding the allegation; however, the residents interviewed were unable to provide information relevant to the condition of the common bathroom.

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SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 26-AS-20260409145843

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 SAN JOSE	FACILITY NUMBER: 435202847
	VISIT DATE: 08/07/2026

NARRATIVE

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On 04/10/2026, LPA Partoza reviewed information received from RP, including email communications and photographs depicting the reported conditions of the Memory Care common bathroom and resident areas.

On 04/10/2026, 04/29/2026, and 06/05/2026, LPA Partoza inspected the Memory Care unit, including the common bathroom and resident rooms. LPA observed hand soap, toilet paper, paper towels, and toilet seat covers available in the common bathroom. LPA did not observe visible fecal residue on the toilet, sticky flooring, overflowing trash receptacles, or visible accumulation of debris during the inspections.

Based on interviews, inspections, and records reviewed, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that staff did not ensure residents’ personal hygiene needs were met or that staff did not maintain the facility in a safe, sanitary condition. Therefore, the allegations are unsubstantiated.

No deficiencies are being cited during today's visit based on the California Code of Regulation (CCR) Title 22. An exit interview was conducted with BOD/Manager in Charge of the day Frank LIm and a copy of the report was provided.

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end of report

SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Maria Partoza
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2026

LIC9099 (FAS) - (06/04)

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