197608477-8-29-2024-31-AS-NMAN-D9ASBU-20240920134430

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608477
Report Date: 08/29/2024
Date Signed: 08/29/2024 03:48:12 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/25/2024 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20240325101907

FACILITY NAME:	IVY PARK AT STUDIO CITY		FACILITY NUMBER:	197608477
ADMINISTRATOR:	SHAHIN TAGHIZADEH		FACILITY TYPE:	740
ADDRESS:	4610 COLDWATER CANYON AVE		TELEPHONE:	(818) 505-8484
CITY:	STUDIO CITY	STATE: CA	ZIP CODE:	91604
CAPACITY:	121	CENSUS: 67	DATE:	08/29/2024
		UNANNOUNCED	TIME BEGAN:	10:13 AM
MET WITH:	Faraz Kashani, Executive Director		TIME COMPLETED:	03:50 PM

ALLEGATION(S):

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Staff are mismanaging resident's medications.
Staff does not safeguard resident's personal belongings.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced subsequent complaint visit to this facility to investigate the above allegations. LPA met with Faraz Kashani and explained the reason for the visit.

---Staff are mismanaging resident's medications.

It was alleged that medication distribution is done by improperly trained staff which cause mix-ups in resident’s medications. To investigate the allegation, LPA requested pertinent documents at 11:00 AM and interviewed five (05) staff and one (01) resident between 11:30 AM to 04:30 PM. On 08/29/2024, LPA interviewed an additional three (03) residents from around 1:30 PM - 2:30 PM. A review of R1’s medication administration records shows R1 was given their medications as prescribed. Staff record reviews also revealed there is at minimum one (01) trained staff per shift for medications.

(CONT. on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024

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 31-AS-20240325101907

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: IVY PARK AT STUDIO CITY	FACILITY NUMBER: 197608477
	VISIT DATE: 08/29/2024

NARRATIVE

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During interviews with staff, all staff stated there are trained staff available during all shifts to distribute medications as prescribed. During interviews with residents, LPA terminated interview with R1 for other reasons. All other residents stated they are given their medications as prescribed. LPA was unable to interview other memory care residents.

Based on record reviews and interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

--- Staff does not safeguard resident's personal belongings.

It was alleged that there are complaints by residents of thefts. To investigate the allegations, LPA requested pertinent documents at 11:00 AM and interviewed five (05) staff and one (01) resident between 11:30 AM to 04:30 PM. On 08/29/2024, LPA interviewed an additional three (03) residents from around 1:30 PM - 2:30 PM. Record review revealed that facility has theft and loss policy and procedures. A review of R1's Resident Personal Property and Valuables form was blank and signed by responsible party. During interviews with staff, all staff stated they are unaware of any theft or missing belongings for R1. During interviews with residents, LPA terminated interview with R1 for other reasons. All other interviewed residents stated they are unaware of any missing belongings or theft. LPA was unable to interview other memory care residents.

Based on record review and interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

No health and safety hazards noted during the visit.

Exit interview conducted. Copy of this report issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024

LIC9099 (FAS) - (06/04)

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