198204069-11-15-2024-11-AS-SCIS-DC52Y2-20241219164758

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204069
Report Date: 06/13/2024
Date Signed: 11/15/2024 09:19:22 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/03/2024 and conducted by Evaluator David Espana

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20240603080145

FACILITY NAME:	IVY PARK AT SANTA MONICA		FACILITY NUMBER:	198204069
ADMINISTRATOR:	VILLARUZ, JUDITH UY		FACILITY TYPE:	740
ADDRESS:	1312 15TH ST		TELEPHONE:	(310) 899-1976
CITY:	SANTA MONICA	STATE: CA	ZIP CODE:	90404
CAPACITY:	100	CENSUS: 74	DATE:	06/13/2024
		UNANNOUNCED	TIME BEGAN:	07:53 AM
MET WITH:	Patricia Murphy, Executive Director/ROS		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff did not safeguard resident’s personal belongings

INVESTIGATION FINDINGS:

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** This report serves as an amendment to clarify findings. It does not supersede the complaint investigation findings reflected on report created 06/13/2024.**

On 06/13/2024 at 08:00 am the department conducted an initial complaint investigation for the allegation listed above. Upon arriving at the facility, LPA met with Henry Reyes, Business Office Director and Patricia Murphy, Executive Director who assisted with the visit. The purpose of today’s visit was discussed. LPA was granted access and allowed to enter the facility to conduct inspections.

The investigation consisted of the following: On 06/13/2024 the department requested a review of current staff/resident roster, admissions agreement, house rules, pre-placement appraisal, and resident personal property and valuables. On 06/13/2024 the deparmtent interviewed Staff 1- Staff 6 (S1-S6) and Resident 1- Resident 6 (R1-R6).
Continued on 9099-C

Continued on LIC 9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Benita Yates	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024

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 11-AS-20240603080145

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: IVY PARK AT SANTA MONICA	FACILITY NUMBER: 198204069
	VISIT DATE: 06/13/2024

NARRATIVE

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The investigation revealed the following: Allegation: Staff did not safeguard resident’s personal belongings.

On 06/13/2024 the department interviewed Patricia Murphy, Executive Director who denied the allegation. On 6/13/2024 the department interviewed Staff 1-Staff 6 (S1-S6). Of those interviewed, 6 out of 6 staff denied the allegation. On 6/13/2024 the department interviewed resident 1 to resident 6 ( R1-R6). Of those interviewed, 6 out of 6 denied the allegations. On 06/13/2024 the department toured rooms #209, #204, #219, and #221, observing that residents' belongings were secured.

Based on LPA’s observation, interviews conducted, and records reviewed, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

Exit Interview conducted and a copy of this report was provided to the facility representative.

SUPERVISOR'S NAME: Benita Yates	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20240603080145

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: IVY PARK AT SANTA MONICA	FACILITY NUMBER: 198204069
	VISIT DATE: 06/13/2024

NARRATIVE
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SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: David Espana	TELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024

LIC9099 (FAS) - (06/04)

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