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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803921
Report Date: 08/25/2026
Date Signed: 08/25/2026 02:25:05 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/14/2026 and conducted by Evaluator Christi Coppo
COMPLAINT CONTROL NUMBER: 21-AS-20260714081515
FACILITY NAME:IVY PARK AT GLEN COVEFACILITY NUMBER:
486803921
ADMINISTRATOR:MOSES, CANDICEFACILITY TYPE:
740
ADDRESS:140 GLEN COVE MARINA ROADTELEPHONE:
(707) 653-4728
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY:155CENSUS: DATE:
08/25/2026
UNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Gina Lapid, Memory Care DirectorTIME COMPLETED:
02:39 PM
ALLEGATION(S):
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Staff do not ensure resident's hygiene needs are met
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christi Coppo arrived at this facility unannounced, to continue an investigation into the above allegation. LPA was greeted by concierge. LPA met with Gina Lapid, Memory Care DIrector (MCD). Executive Director Richie Remigio was also present.

Complaint alleges facility does not ensure resident's hygiene needs are met. During investigation, LPA reviewed shower log for resident (R1). Review of facility 'Shower Skin Sheet' form indicates that upon a resident refusing a shower, the form shall be signed by a caregiver, a LVN/medtech, and identify a date to which the shower was moved. Form indicates that “shower must be moved to the next day if there is a refusal." Review of shower refusals for R1 indicate approximately thirteen (13) instances of showers being refused over the course of approximately three (3) months. However, "date shower moved to" on each shower refusal is blank, indicating showers were not rescheduled. Based on LPA record review, 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 Chapter 8, are being cited on the attached 9099D.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2026
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/14/2026 and conducted by Evaluator Christi Coppo
COMPLAINT CONTROL NUMBER: 21-AS-20260714081515

FACILITY NAME:IVY PARK AT GLEN COVEFACILITY NUMBER:
486803921
ADMINISTRATOR:MOSES, CANDICEFACILITY TYPE:
740
ADDRESS:140 GLEN COVE MARINA ROADTELEPHONE:
(707) 653-4728
CITY:VALLEJOSTATE:CAZIP CODE:
94591
CAPACITY:155CENSUS: DATE:
08/25/2026
UNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Gina Lapid, Memory Care DirectorTIME COMPLETED:
02:39 PM
ALLEGATION(S):
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Staff do not ensure resident is adequately hydrated
Staff do not ensure resident has clean bed linens
Staff do not ensure resident's room is maintained clean
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Christi Coppo arrived at this facility unannounced, to continue an investigation into the above allegations. LPA was greeted by concierge. LPA met with Gina Lapid, Memory Care DIrector (MCD). Executive Director Richie Remigio was also present.

Complaint alleges facility does not ensure resident (R1) is adequately hydrated. During investigation, LPA reviewed physician's report for R1. Physician's report does not indicate any special diet requried and does not specify any special hydration requirements. During investigation, LPA reviewed R1's care plan. Care plan does not denote any special care needs or any special instructions for meals or hydration, except that R1 needs reminders to attend mealtimes. MCD provided hydration log for R1 for month of July 2026 showing R1 was provided both water and juice each day. So, 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

Continued on 9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 21-AS-20260714081515
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: IVY PARK AT GLEN COVE
FACILITY NUMBER: 486803921
VISIT DATE: 08/25/2026
NARRATIVE
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Continued from 9099A...

allegation is UNSUBSTANTIATED.

Complaint alleges that staff does not ensure resident (R1) has clean bed linen and that staff do not ensure R1's room is maintained clean. During investigation, LPA reviewed R1's Admission Agreement which states that housekeeping services, including laundry, will be offered one time per week. During investigation, LPA conducted interviews. Staff indicate that housekeeping duties in Memory Care (MC) are performed twice a week. MC caregivers do the laundry for MC. Laundry is done on the overnight shift (NOC) and then AM shift puts it away. If there are incontinence issues then the soiled items are taken care of immediately, including bed linens if they are soiled as a result. During investigation, LPA received photographic evidence of the condition of R1's room. Review of photographic evidence shows R1's room as clean, neat, and tidy, with bed made and room free of clutter and garbage. During course of investigation, LPA visited facility three (3) times. Each time, LPA toured R1's room and found it to be clean, neat, and tidy, with bed made and bed linens to be clean, not soiled. LPA observed carpet to be clean overall and was not soiled. So, 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.

Exit interview conducted with ED and MCD and a copy of this report given.
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 21-AS-20260714081515
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: IVY PARK AT GLEN COVE
FACILITY NUMBER: 486803921
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/25/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/01/2026
Section Cited
CCR
87464(f)(4)
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87464(f)(4) Personal assistance and care as needed by the resident... with those activities of daily living such as dressing, eating, bathing...

This requirement not met by Licensee as evidenced by:
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Licensee shall submit proof of in-service training for caregivers regarding showering and documentation by Plan of Correction due date.
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Based upon record review, R1 refusal showers were not rescheduled as required by facility policy, which poses a potential risk to the Health, Safety and Personal Rights of residents in care.
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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: Victoria Bertozzi
LICENSING EVALUATOR NAME: Christi Coppo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/25/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4