197609362-11-6-2024-31-AS-NMAN-DCNUFJ-20250106143250

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609362
Report Date: 11/06/2024
Date Signed: 11/06/2024 03:03:19 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
01/16/2024 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20240116093357

FACILITY NAME:	IVY PARK AT BURBANK		FACILITY NUMBER:	197609362
ADMINISTRATOR:	DAWN SMITH		FACILITY TYPE:	740
ADDRESS:	2721 WILLOW STREET		TELEPHONE:	(818) 954-9500
CITY:	BURBANK	STATE: CA	ZIP CODE:	91505
CAPACITY:	130	CENSUS: 85	DATE:	11/06/2024
		UNANNOUNCED	TIME BEGAN:	10:56 AM
MET WITH:	Beatriz Martinez		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Facility staff are not responding to the residents setting off the beeper system at the main entrance of the facility.
Facility staff do not respond to the residents calls for assistance in a timely manner.
Facility staff are not qualified.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced subsequent complaint visit to the facility to investigate the above allegation. LPA met with Beatriz Martinez and explained the reason for the visit.

--- Facility staff are not responding to the residents setting off the beeper system at the main entrance of the facility.

It was alleged that residents with memory loss wander the ground floor and set off beeper system at main entrance, then nobody responds to help. To investigate the allegation, LPA conducted a physical plant tour at around 11:00a.m. and interviewed four (04) staff. During the physical plant tour, LPA observed two (02) delayed egress doors on opposite ends of the second floor.

(CONT. on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2024

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-20240116093357

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 BURBANK	FACILITY NUMBER: 197609362
	VISIT DATE: 11/06/2024

NARRATIVE

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To test staff response time, LPA triggered delayed egress alarms multiple times and observed an average response time of fifteen (15) seconds. LPA also observed three (03) caregivers and one (01) MedTech providing care to seventeen (17) memory care residents. During interviews with staff, all staff stated they respond to the delayed egress alarm within five (05) to fifteen (15) seconds.

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

--- Facility staff do not respond to the residents calls for assistance in a timely manner.

It was alleged that help calls taking twenty (20) to thirty (30) minutes to get to residents’ rooms. To investigate the allegation, LPA conducted a physical plant tour at around 11:00a.m. and interviewed four (04) staff. During the physical plant tour, LPA selected six (06) rooms at random, used the call button system and observed an average response time of five (05) minutes. LPA also observed three (03) caregivers and one (01) MedTech providing care to seventeen (17) memory care residents. During interviews with staff, all staff stated they respond to the resident call buttons within three (03) to six (06) minutes.

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

--- Facility staff are not qualified.

It was alleged that there is a lack of a qualified manager to handle the safety of confused elderly. To investigate the allegation, LPA requested records at around 12:00p.m. A review of staff files revealed that the manager at the time the complaint was filed had all required training, including Elopement Response Plan, CPR, First Aid and Service Excellence with Residents and Families training.

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

No health and safety hazards were noted during the visit.
Exit interview conducted and a copy of the report was issued.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2024

LIC9099 (FAS) - (06/04)

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