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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610520
Report Date: 12/04/2025
Date Signed: 12/04/2025 12:51:12 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
06/12/2025 and conducted by Evaluator Nadia Shahbazian
COMPLAINT CONTROL NUMBER: 31-AS-20250612084010
FACILITY NAME:IVY PARK AT STUDIO CITYFACILITY NUMBER:
197610520
ADMINISTRATOR:KASHANI, FARAZFACILITY TYPE:
740
ADDRESS:4610 COLDWATER CANYONTELEPHONE:
(818) 505-8484
CITY:STUDIO CITYSTATE: CAZIP CODE:
91604
CAPACITY:121CENSUS: 78DATE:
12/04/2025
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Tammie Sampedro - Interim Executive DirectorTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Staff is not ensuring resident is receiving proper wound care.
INVESTIGATION FINDINGS:
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On 12/04/25 at 10:30AM Licensing Program Analyst (LPA) Nadia Shahbazian conducted an unannounced subsequent complaint visit to the facility to conclude the investigation regarding the above allegation. LPA met with Tammie Sampedro - Interim Executive Director and Health Services Director Lindsay Light and advised of the complaint.

On 06/13/25 the Community Care Licensing Division received a complaint regarding Resident 1 (R1). On 06/13/25 the complaint was referred to Investigation Branch (IB). On 06/16/25 IB returned the complaint to the Regional Office (RO) for investigation.

The Initial investigation was conducted on 06/13/25 by Licensing Program Analyst (LPA) Jose Tan when he met with Daisy Hernenandez, Business Office Manager. On this date LPA Tan interviewed staff and residents and obtained pertinent documents. LPA Tan was unable to interview Resident 1 (R1) but was informed that R1 was hospitalized and will not come back to the facility.

Continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Nadia Shahbazian
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2025
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 2
Control Number 31-AS-20250612084010
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 STUDIO CITY
FACILITY NUMBER: 197610520
VISIT DATE: 12/04/2025
NARRATIVE
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On 09/09/25 and 11/06/25 LPA Shahbazian conducted subsequent complaint visits and interviewed staff and gathered pertinent documents. LPA Shahbazian conducted a physical plant tour, to ensure health and safety of the residents are protected and physical plant is in compliance with Title 22 Regulations. No immediate health issues were observed.

Regarding the allegation: Staff is not ensuring resident is receiving proper wound care. It is being alleged that R1 was found to have stage IV pressure wounds that may have developed while in care.

Interview with family member (W1) revealed that R1 had recurring UTIs and wounds. W1 stated on 04/19/25 R1 was admitted to Ivy Park with a neck brace and catheter but the wounds were not very serious. Record review of a Healthcare Center Order Summary Report dated 04/19/25 reveals that resident had many medical issues, including personal history of other malignant neoplasm of skin with mention of wound care but there are no specifics about type/stage of wounds or body parts. Upon R1’s move to Ivy Park on 04/22/25, the facility med tech noticed wounds to buttock and sacrum. On 04/22/25 an initial home health assessment was done by Comcare Home Health. Wounds noted on buttock, sacrum and bilateral heels, with recommendations for treatment 3 times weekly but specific wound stages were not noted on the initial Comcare report. Comcare Home Health nurses were scheduled to visit R1 3 times weekly for changing the catheter and wound care, including cleansing, applying medication and covering with foam dressing and repositioning resident. On 05/17/25 new wound on right shoulder and buttock was noticed, after returning from a hospitalization period. On 6/4/25 resident had a change in appetite and inflamed shoulder wound. R1 was sent back to Kaiser Panorama City Hospital and W1 was notified.

LPA’s interviews with facility staff revealed that R1 was admitted to facility without clear indication of wounds. Facility med techs were responsible for cleansing and changing the dressings, as needed. Care givers were responsible for repositioning R1 every 2 hours and to ensure wounds are protected and by placing pillows near wounds. Interview with W1 revealed that it is unclear when and in which facility wounds appeared and worsened. Based on record reviews and interviews, it is determined that facility provided care and arranged for wound and physical care. The progression of R1’s wounds did not indicate neglect or failure to seek medical care. There is insufficient information to prove that the wounds worsen while R1 was in care of the facility, therefore, the allegation is deemed Unsubstantiated at this time.

Exit interview conducted and copy of this report signed and delivered.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Nadia Shahbazian
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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