197610501-12-26-2024-31-AS-AJWR-DPC34C-20251213165455

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610501
Report Date: 12/26/2024
Date Signed: 12/26/2024 05:20:26 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
12/20/2024 and conducted by Evaluator Perchui Khurshudyan

COMPLAINT CONTROL NUMBER: 31-AS-20241220102450

FACILITY NAME:	IVY PARK AT WEST HILLS		FACILITY NUMBER:	197610501
ADMINISTRATOR:	LIDIA CAUCHI		FACILITY TYPE:	740
ADDRESS:	9012 TOPANGA CANYON ROAD		TELEPHONE:	(818) 701-9550
CITY:	WEST HILLS	STATE: CA	ZIP CODE:	91304
CAPACITY:	90	CENSUS: 57	DATE:	12/26/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Alma Fuentes-Memory care Director		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Staff does not allow residents to possess personal belongings.
Staff does not ensure that residents' incontinence needs are met.
Staff confines residents to bedrooms.
Staff does not answer residents' call buttons in a timely manner.
Staff does not ensure that resident is afforded a comfortable accommodation.
Staff speaks inappropriately to residents.

INVESTIGATION FINDINGS:

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At 09:30am, Licensing Program Analysts (LPAs) Perchui Milena Khurshudyan and Angela Panushkina conducted an initial visit to investigate the above allegations. LPAs met with the Memory Care Director (MCD) and explained the reason for the visit.

During course of the investigation, interviews and record review were made. At 9:35am, LPAs requested resident and staff roster. At 09:40am, LPAs requested copies of pertinent information which include, but not limited to Policy and Procedures for an Emergency Response System, Emergency Call Log, etc., relevant to the investigation. At approximately 9:50am, LPA conducted a physical plant tour, to ensure health and safety of the residents are protected. Between 10:00am – 1:00pm, LPAs conducted interviews with the Memory Care Director (MCD), four (4) staff members, one (1) MedTech, six (6) residents and one (1) witness. Also, while interviewing a sample of six (6) residents, LPAs randomly tested resident’s emergency pull cords in rooms and bathrooms.
Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Perchui Khurshudyan
LICENSING EVALUATOR SIGNATURE:	DATE: 12/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2024

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-20241220102450

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: IVY PARK AT WEST HILLS	FACILITY NUMBER: 197610501
	VISIT DATE: 12/26/2024

NARRATIVE

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Allegation: Staff does not allow residents to possess personal belongings
It was alleged that on 12/14/2024, 12/15/2024 and 12/16/2024, S1 took Memory Care Unit (MCU) residents' wheelchairs and walkers and placed them far away from residents, so that the residents didn't get out of bed. To investigate this allegation, LPAs conducted an interview with a Memory Care Director, four (4) staff and one (1) MedTech and all parties interviewed denied the above allegation. Moreover, LPAs conducted interviews with six (6) residents and one witness. LPAs were informed that all facility staff members provide an excellent care with dignity and respect. In addition, all residents and a witness interviewed expressed no concerns regarding this allegation. Therefore, based on interviews this allegation is deemed Unsubstantiated, at this time.

Allegation: Staff does not ensure that residents' incontinence needs are met
It was alleged that S1 does not change residents' diapers during the shift. To investigate this allegation, LPAs conducted interviews with the Memory Care Director (MCD) and were informed that their current census in a Memory Care Unit (MCU) is thirteen and during the morning (6:00am-2:00pm) and afternoon (2:00pm-10:00pm) shifts the MCU has three (3) staff members and one (1) MedTech and during the night shift (10:00pm-6:00am), the facility has two (2) staff members and one (1) MedTech available. LPAs were also informed that all incontinent residents are being changed at least three (3) times per shift and/or as needed. Four (4) staff members interviewed corroborated with the statement provided by the MCD. In addition, LPAs conducted interviews with three (3) residents and one witness from the Memory Care Unit and three (3) residents from the Assisted Living. All parties interviewed expressed no concerns regarding this allegation. Therefore, based on interviews and LPAs observations, this allegation is deemed Unsubstantiated, at this time.

Allegation: Staff confines residents to bedrooms
It was alleged that the S1 abuses residents during his/her work shift. To investigate this allegation, LPAs conducted an interview with a Memory Care Director (MCD) and were informed that this issue was brought up to her attention about two (2) weeks ago and she conducted her own investigation by interviewing with two (2) night shift staff members and made unannounced visits during the night shift to observe the staff and make sure that the health and safety of the residents are protected. During todays’ visit, LPAs contacted three (3) night shift staff members, who denied the above allegation. Moreover, three (3) residents from the MCU informed LPAs that they really like S1 and the care provided by S1 and expressed no concerns regarding this allegation. Therefore, based on interviews this allegation deemed Unsubstantiated, at this time.
Continue on LIC9099-C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Perchui Khurshudyan
LICENSING EVALUATOR SIGNATURE:	DATE: 12/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 31-AS-20241220102450

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: IVY PARK AT WEST HILLS	FACILITY NUMBER: 197610501
	VISIT DATE: 12/26/2024

NARRATIVE

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Allegation: Staff does not answer residents' call buttons in a timely manner
To investigate this allegation while interviewing a sample of six (6) residents, LPAs randomly tested resident’s emergency call buttons in their rooms and bathrooms. LPAs conducted a random inspection of five (5) emergency call buttons, and staff responded within a reasonable time. Interview with the Memory Care Director revealed that the facility’s expectation for response time is three (3) minutes. Moreover, interviews with four (4) staff members revealed that they respond to residents' call buttons immediately and if, for any reason, a staff member is not available to assist, they communicate with each other to make sure the call/page is being taking care of right away. In addition, interviews with six (6) residents revealed that the staff always response immediately and expressed no concerns about the above allegation. Based on interviews, LPAs observation and review of the information received, this allegation is deemed Unsubstantiated at this time.

Allegation: Staff does not ensure that resident is afforded a comfortable accommodation
It was alleged that S1 placed the residents' pillows and blankets on the floor, then placed the residents on the floor to sleep, so that the residents couldn't get up. To investigate this allegation, LPAs conducted an interview with the Memory Care Director (MCD) who denied the above allegation and informed LPAs that no such approach towards residents were brought up to her attention. LPAs were also informed in the month of November S1 was recognized as an “Employee of the Month” for being so kind, caring, and favorite to residents. In addition, LPAs conducted an interview with S1 who also denied this allegation and informed LPAs that he/she always provides care to all residents with dignity and respect. Moreover, four (4) staff and six (6) residents interviewed, expressed no concerns regarding this allegation. Therefore, based on interviews this allegation deemed Unsubstantiated, at this time.

Allegation: Staff speaks inappropriately to residents
It was alleged that S1 yells at residents when the residents try to leave their rooms. To investigate this allegation, LPAs conducted an interview with the Memory Care Director, six (6) staff and one (1) MedTech. All parties interviewed denied the above allegation and informed LPAs that they haven’t witness nor heard S1 yelling and or inappropriately speaking with the residents. Moreover, interviews with three (3) residents and one (1) witness from a Memory Care Unit expressed no concerns regarding this allegation. Therefore, based on interviews this allegation deemed Unsubstantiated, at this time.
No deficiency cited during today's visit.
Exit interview conducted and copy of this report signed and delivered

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Perchui Khurshudyan
LICENSING EVALUATOR SIGNATURE:	DATE: 12/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2024

LIC9099 (FAS) - (06/04)

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