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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610501
Report Date: 12/26/2024
Date Signed: 12/11/2025 01:15:02 PM

Substantiated


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
11/19/2024 and conducted by Evaluator Perchui Khurshudyan
COMPLAINT CONTROL NUMBER: 31-AS-20241119092225
FACILITY NAME:IVY PARK AT WEST HILLSFACILITY NUMBER:
197610501
ADMINISTRATOR:LIDIA CAUCHIFACILITY TYPE:
740
ADDRESS:9012 TOPANGA CANYON ROADTELEPHONE:
(818) 701-9550
CITY:WEST HILLSSTATE: CAZIP CODE:
91304
CAPACITY:90CENSUS: 57DATE:
12/26/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Alma Fuentes-Memory Care DirectorTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Staff did not utilize universal precautions to care for residents affected with scabies.
INVESTIGATION FINDINGS:
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This is an Amendment to the original report issued on 12/26/2024. Additional information was added to clarify the investigation.

On 11/25/2024, during the initial ten-day complaint visit conducted by LPA Khurshudyan, LPA obtained copies of the staff and resident rosters and requested ten (10) resident files. At 11:45am, LPA conducted a physical plant tour including the Memory Care Unit to ensure health and safety of the residents are protected. In addition, between 12:30pm and 3:30pm LPA reviewed files and interviewed eight (8) out of seventy-one (71) residents who were able to communicate; four (4) from the Assisted Living, four (4) from Memory Care Unit, and total of five (5) staff members including Executive Director, and four (4) caregivers/Med-Techs. Interviews with the Executive Director (ED) and staff revealed that residents at Memory Care unit had some type of rash and itching on their skin for the past few months. Continue on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Perchui Khurshudyan
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
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 3
Control Number 31-AS-20241119092225
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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During the subsequent visit conducted on 12/26/24, LPA Khurshudyan collected staff and resident rosters, toured the physical plant at 10:00am and interviewed Memory Care Director Alma Fuentes.

Review of medical records confirmed that two (2) residents were seen by their primary physicians and diagnosed with scabies on 11/15/24 and 11/21/2024. Topical medication was prescribed for treatment. Additionally, three (3) staff members reported having skin irritation and itching during the same time frame. Records review showed that the first Incident Report submitted to CCL regarding a resident with body itching was received on 9/5/2024 and per SIR an anti-itch powder applied. Further interviews with staff members confirmed that the skin rash issue started about five (5) months ago, and almost every resident in Memory Care unit had rash and itchy skin. Documentation review indicated that although the facility was aware of two (2) confirmed scabies diagnosis, and at least seven (7) residents with skin rash problems, staff did not follow Universal Precautions at the facility. The facility failed to immediately notify all staff of the confirmed scabies cases and did not ensure that appropriate infection control measures were implemented throughout the affected unit. Interviews with the Memory Care Director revealed that the facility relied solely on the facility’s doctor’s evaluation and did not implement preventive measures as required by Universal Precautions reporting to Department of Public Health on time.

Based on interviews, records review, and observations, there is sufficient evidence to support that staff did not utilize universal precautions while caring for residents affected with skin rash which posed rash epidemic within the Memory Care unit. Therefore, the allegation is substantiated.

Deficiency issued on LIC9099-D.

Exit interview conducted, appeal rights explained and copy of this report delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Perchui Khurshudyan
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Citations on this Visit Report are Under Appeal!

Control Number 31-AS-20241119092225
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type A
12/11/2025
Section Cited
CCR
87470(b)(1)(A)
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Infection Control Req's. (b)when 1 or more residents in the facility are diagnosed with a contagious disease... (1)assigned staff...shall be required to perform enhanced environmental cleaning and... (A)The licensee shall consult with a medical professional...
This requirement was not meet as evidenced by:

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The Executive Director agreed to conduct In-service training with all staff regarding this Section. Training materials will be submitted to LPA.
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Based on interviews and record review the Licensee did not comply with the section cited above, by not following Universal Precaution which resulted spread of rashes/scabies within Memory Care Unit, which poses an immediate health, safety, and personal rights risk to resident 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.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Perchui Khurshudyan
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
LIC9099 (FAS) - (06/04)
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