Inspection Reports for Ivy Park at San Jose
4855 San Felipe Rd, San Jose, CA 95135, United States, CA, 95135
Back to Facility ProfileInspection Report Summary
Most inspections found no deficiencies, including the most recent complaint investigation on August 8, 2025, which found the allegations unfounded and cited no issues. Earlier reports show isolated serious deficiencies related to resident supervision and safety, notably a substantiated complaint in June 2024 where a resident with dementia eloped, resulting in three deficiencies and a $500 fine. Prior to that, a similar elopement issue was cited in 2022, indicating some past challenges with supervision and safety measures for residents with dementia. Several complaint investigations over the last two years were unsubstantiated, and annual inspections consistently found the facility in compliance with regulations. The overall trend shows improvement, with recent reports free of deficiencies following earlier enforcement actions.
Deficiencies per Year
4
3
2
1
0
High
Unclassified
Census Over Time
Census
Capacity
Inspection Report
Complaint Investigation
Census: 103
Capacity: 140
Deficiencies: 0
Aug 8, 2025
Visit Reason
The inspection was conducted as an unannounced complaint investigation following a complaint received on 2025-05-13 alleging that staff were not providing necessary assistance to a resident regarding filing long-term care insurance paperwork.
Findings
The investigation found that the facility was not responsible for submitting all forms to the long-term care insurance company, and that the resident or responsible party was responsible for submitting paperwork. Staff interviews and record reviews showed that the resident was always provided care and assistance. The allegation was determined to be unfounded with no deficiencies cited.
Complaint Details
The complaint alleged that staff failed to provide assistance in filing a resident's long-term care insurance paperwork, causing delayed reimbursement. The investigation found the allegation unfounded based on interviews, record review, and observation.
Report Facts
Complaint Control Number: 26
Complaint received date: May 13, 2025
Staff interviewed: 2
Staff interviewed denying care stopped: 8
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Christine Kabariti | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Val Baldugo-Macasieb | Executive Director | Met with Licensing Program Analyst during investigation and reviewed report |
| Jackie Jin | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Capacity: 140
Deficiencies: 0
Jul 15, 2025
Visit Reason
The visit was conducted as a case management incident follow-up regarding a video posted on social media showing a resident being mistreated by his/her authorized representative in a public setting.
Findings
Seven staff members were interviewed and all denied knowledge or observation of mistreatment by the authorized representative. The resident mentioned the representative was 'mean' but did not provide details. Frequent checks were implemented for the resident's safety. No deficiencies were cited.
Complaint Details
The complaint involved allegations of mistreatment of a resident by his/her authorized representative based on a social media video. Staff interviews did not substantiate the allegations. The incident was cross-reported to other agencies for further investigation.
Report Facts
Staff interviewed: 7
Capacity: 140
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Frank Lim | Business Office Director | Met with during the inspection and reviewed the report |
| Christine Kabariti | Licensing Program Analyst | Conducted the case management incident visit |
| Jackie Jin | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Annual Inspection
Census: 114
Capacity: 140
Deficiencies: 0
May 13, 2025
Visit Reason
The inspection visit was an unannounced Case Management - Annual Continuation visit, continuing from the annual inspection visit that occurred on 2025-04-22.
Findings
During the visit, staff and resident records were reviewed, including medication and destruction records, and all were found to be complete. No deficiencies were cited at this time as per California Code of Regulations Title 22.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| David Marrufo | Licensing Program Analyst | Conducted the inspection and reviewed records |
| Val Baldugo-Macasieb | Executive Director | Met with Licensing Program Analyst during inspection |
Inspection Report
Annual Inspection
Census: 112
Capacity: 140
Deficiencies: 0
Apr 22, 2025
Visit Reason
An unannounced required 1 year annual inspection was conducted to evaluate compliance with licensing requirements.
Findings
The facility was toured and inspected including common areas, resident rooms, kitchen, and safety systems. No deficiencies were cited during this annual inspection. Fire and disaster drill training was confirmed, and pest control measures were in place.
Report Facts
Capacity: 140
Census: 112
Water temperature: 118
Water temperature: 120
Fire extinguisher inspection dates: 2024
Fire and disaster drill training date: Feb 21, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Val Baldugo-Macasieb | Executive Director/Administrator | Met with Licensing Program Analyst during inspection and exit interview |
| Maria Partoza | Licensing Program Analyst | Conducted the inspection and signed the report |
| Karina Nevarez | Administrator/Director | Named as facility administrator/director |
Inspection Report
Census: 112
Capacity: 140
Deficiencies: 0
Apr 22, 2025
Visit Reason
An unannounced case management visit was conducted to follow up on previously cited deficiencies and to evaluate the facility's compliance with licensing requirements.
Findings
No deficiencies were cited during this visit. The facility demonstrated installation and proper functioning of a wander guard alarm system for residents with early onset dementia, and staff presence was observed at all times in the reception area to monitor resident sign-in and sign-out.
Report Facts
Capacity: 140
Census: 112
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Val Baldugo-Macasieb | Executive Director / ADM | Met with Licensing Program Analyst during the inspection and demonstrated the wander guard alarm system |
| Maria Partoza | Licensing Program Analyst | Conducted the unannounced case management deficiencies visit |
Inspection Report
Complaint Investigation
Census: 120
Capacity: 140
Deficiencies: 0
Nov 15, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations that staff did not administer a resident's medication as prescribed and did not seek medical attention in a timely manner.
Findings
The investigation found that the resident was under hospice care and the facility staff followed hospice protocols by contacting the hospice nurse for advice. The allegations were determined to be unfounded, with no citations issued.
Complaint Details
The complaint alleged that staff did not administer resident R1's PRN medication and did not seek medical attention promptly. The investigation found that the resident was under hospice care, the medication was managed by the family member with hospice approval, and the facility staff contacted the hospice nurse as required. The allegation was found to be unfounded.
Report Facts
Time to obtain PRN medication: 37
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Karina Nevarez | Executive Director | Interviewed regarding resident care and medication administration |
| Val Baldugo Macasieb | Business Office Director | Met with Licensing Program Analyst during investigation |
| Steve Chang | Licensing Program Analyst | Conducted the unannounced complaint investigation visit |
| Chihhsien Chang | Licensing Program Analyst | Conducted the complaint investigation and signed the report |
| Romeo Manzano | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Complaint Investigation
Census: 116
Capacity: 140
Deficiencies: 0
Aug 27, 2024
Visit Reason
An unannounced case management visit was conducted regarding an incident report received on 2024-08-23 involving a resident.
Findings
No deficiencies were cited during the visit. Due to insufficient information, the case management will remain open until further investigation.
Complaint Details
Visit was complaint-related based on an incident report received on 2024-08-23. The case remains open due to insufficient information.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Maria Partoza | Licensing Program Analyst | Conducted the unannounced case management visit. |
| Karina Nevarez | Executive Director/Administrator | Met with Licensing Program Analyst during the visit. |
| Romeo Manzano | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Complaint Investigation
Census: 124
Capacity: 140
Deficiencies: 0
Jul 9, 2024
Visit Reason
The visit was an unannounced complaint investigation triggered by allegations received on 2022-06-10 regarding insufficient staffing response to call buttons, inadequate meal provision, and thermostat disrepair.
Findings
The investigation found no evidence to substantiate the allegations. Staff were found to respond to call buttons within reasonable time, residents received three meals daily in a timely manner, and thermostat issues were resolved promptly with no ongoing problems.
Complaint Details
The complaint included allegations that staff were not answering resident call buttons timely due to insufficient staffing, residents were not receiving at least three meals a day or meals timely, and thermostats in residents' rooms were in disrepair. The findings were unsubstantiated with no citations issued.
Report Facts
Capacity: 140
Census: 124
Resident interviews: 9
Staff interviews: 2
Resident interviews: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Steve Chang | Licensing Program Analyst | Conducted the unannounced investigation visit and delivered findings |
| Val Baldugo | Business Office Director | Met with Licensing Program Analyst during investigation |
| Sara Post | Administrator | Facility administrator named in report header |
| Chihhsien Chang | Licensing Program Analyst | Signed the complaint investigation report |
| Romeo Manzano | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Census: 124
Capacity: 140
Deficiencies: 0
Jul 9, 2024
Visit Reason
The inspection was conducted as an unannounced complaint investigation visit following a complaint received on 2022-06-17 alleging insufficient staffing at the facility.
Findings
Based on interviews with staff and residents, observations, and records reviewed, the Department found no evidence to indicate the facility has insufficient staffing. The allegation was determined to be unsubstantiated.
Complaint Details
The complaint alleged that the facility has insufficient staffing. The investigation included interviews with staff and residents, and a facility tour. The allegation was found to be unsubstantiated due to lack of preponderance of evidence.
Report Facts
Staff interviewed: 5
Residents interviewed: 2
Staff interviewed: 7
Residents interviewed: 9
Caregivers on duty: 8
Med Techs on duty: 2
Nurses on duty: 1
Facility capacity: 140
Facility census: 124
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Steve Chang | Licensing Program Analyst | Conducted the unannounced investigation visit and delivered findings |
| Val Baldugo | Business Office Director | Met with Licensing Program Analyst during investigation |
| Sara Post | Administrator | Facility administrator named in report header |
| Romeo Manzano | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
| Chihhsien Chang | Licensing Program Analyst | Conducted complaint investigation and signed report |
Inspection Report
Complaint Investigation
Census: 127
Capacity: 140
Deficiencies: 3
Jun 14, 2024
Visit Reason
The inspection was conducted as an unannounced case management visit triggered by a phone call regarding resident R1 who was discovered missing on June 13, 2024.
Findings
The facility failed to provide adequate supervision to resident R1, who has dementia and eloped from the facility overnight. Deficiencies were cited related to lack of care and supervision, absence of a plan of operation and safety measures for residents with dementia, and administrator's lack of knowledge of applicable laws and regulations. An immediate civil penalty of $500 was assessed.
Complaint Details
The visit was complaint-related due to a phone call reporting resident R1 missing. The resident was found in a hospital after eloping from the facility. The complaint was substantiated by findings of inadequate supervision and safety measures.
Severity Breakdown
Type A: 3
Deficiencies (3)
| Description | Severity |
|---|---|
| Resident R1 eloped from the facility on June 13, 2024 and staff did not provide care and supervision to meet his/her needs, posing an immediate threat to health, safety, or personal rights. | Type A |
| Licensee did not have a plan of operation and safety measures to address the needs of resident R1 diagnosed with dementia who eloped from the assisted living unit. | Request Denied Type A |
| Administrator did not exhibit knowledge of applicable laws, rules, and regulations resulting in serious violations involving a resident who eloped from the facility. | Request Denied Type A |
Report Facts
Civil penalty amount: 500
Residents with dementia: 11
Plan of Correction due date: Jun 15, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| John Doyle | Health Services Director | Met during inspection and named in findings related to resident care and supervision. |
| Karina Nevarez | Administrator | Facility administrator who reported resident missing and was cited for lack of knowledge of laws and regulations. |
| Manuel Monter | Licensing Program Analyst | Conducted the inspection. |
| Romeo Manzano | Licensing Program Manager | Supervisor overseeing the inspection. |
Inspection Report
Annual Inspection
Census: 124
Capacity: 140
Deficiencies: 0
Apr 24, 2024
Visit Reason
An unannounced required annual inspection was conducted to evaluate the facility's compliance with licensing regulations.
Findings
The inspection found no deficiencies; all areas including fire safety, resident records, staff training, medication records, and facility conditions were in compliance. Advisory assistance was provided for future record keeping.
Report Facts
Staff count: 77
Water temperature range: 112
Water temperature range: 116
Food supply duration: 2
Food supply duration: 7
Fire extinguisher last inspection date: May 15, 2023
Fire alarm test dates: Mar 1, 2023
Fire alarm test dates: Mar 18, 2023
Room temperature: 70
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Karina Nevarez | Executive Director | Met with Licensing Program Analyst during inspection and exit interview |
| Maria Partoza | Licensing Program Analyst | Conducted the inspection and authored the report |
| Romeo Manzano | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Census: 98
Capacity: 140
Deficiencies: 1
Jun 17, 2022
Visit Reason
The visit was an unannounced Case Management visit conducted following receipt of an Unusual Incident Report regarding a resident who eloped from the facility without assistance.
Findings
A deficiency was cited for failure to provide necessary assistance to a resident who was not allowed to leave unassisted, posing an immediate risk to the health and safety of the resident in care.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to provide necessary assistance to resident (R1) who cannot leave facility unassisted, resulting in elopement and immediate risk to resident's health and safety. | Type A |
Report Facts
Capacity: 140
Census: 98
Deficiencies cited: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jayden Bettencourt | Memory Care Director | Met during the inspection and involved in exit interview |
| Steve Chang | Licensing Program Analyst | Conducted the unannounced Case Management visit |
| Romeo Manzano | Licensing Program Manager | Supervisor named in the report |
Inspection Report
Original Licensing
Census: 97
Capacity: 140
Deficiencies: 1
Apr 21, 2022
Visit Reason
Unannounced pre-licensing visit conducted to evaluate the facility's readiness for licensure.
Findings
The facility was toured and found to have appropriate living conditions, safety measures, and documentation. The Department is recommending licensure pending a plan of correction for a deficiency issued during the visit. The facility is not yet licensed and subject to final approval by the Central Application Bureau.
Deficiencies (1)
| Description |
|---|
| Deficiency issued during the pre-licensing visit requiring a plan of correction. |
Report Facts
Days of perishables observed: 2
Days of nonperishables observed: 7
Refrigerator temperature (°F): 31
Freezer temperature (°F): 1
Hot water temperature range (°F): 111.3 to 113.3
Resident apartment temperature range (°F): 74 to 77
Fire clearance capacity non-ambulatory residents: 140
Fire clearance capacity bedridden residents: 21
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sara Post | Administrator | Met with Licensing Program Analyst during pre-licensing visit |
| Christine Dolores | Licensing Program Analyst | Conducted the pre-licensing visit and authored the report |
| Jackie Jin | Licensing Program Manager | Named in report header and narrative |
Inspection Report
Census: 98
Capacity: 140
Deficiencies: 0
Mar 9, 2022
Visit Reason
The visit was an office evaluation related to a Change of Ownership application for the Residential Care Facility for the Elderly.
Findings
The applicant and administrator participated in a COMP II telephone interview to verify identification and confirm understanding of California Code Title 22 regulations, covering facility operation, admission policies, staffing, health conditions, emergency preparedness, complaints, and pre-licensing readiness.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jessica Zepeda | Administrator | Named as facility administrator during the evaluation. |
| Sara Post | Executive Director | Participant in COMP II telephone interview. |
| Jude De La Concepcion | Licensing Program Manager | Named in report header. |
| Bethany Hunter | Licensing Program Analyst | Named in report header and signed the report. |
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