198204069-8-16-2023-11-AS-UCOL-CXBUJT-20231106143803

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204069
Report Date: 08/16/2023
Date Signed: 08/16/2023 04:04:44 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/08/2023 and conducted by Evaluator Antonine Richard

COMPLAINT CONTROL NUMBER: 11-AS-20230808094356

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: 66	DATE:	08/16/2023
		UNANNOUNCED	TIME BEGAN:	09:13 AM
MET WITH:	Villaruz, Judith UY		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff left residents in soiled urine/feces resulting in a rash.

Staff providing residents the same plate the dog eats from.

INVESTIGATION FINDINGS:

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On 08/16/2023, Licensing Program Analyst (LPA) Antonine Richard conducted an unannnounced complaint visit at this facility, LPA was greeted by Executive Director Judith Uy-Villaruz. LPA explained the purposed of today's complaint investigations.

The investigation consisted of the following: during today's visit, LPA Richard with Excecutive Director Villaruz conducted the toured of the facility, interviewed ten (10) out of sixty six (66) Residents R1-R10 and interviewed (10) out of seventy six (76) staff C1-C10. LPA also conducted records reviews of staff, facility and resident records. LPA Richard requested copies of staff rand redident rosters, medical records for resident
R1 and R2.

The investigation revealed the following: it is being alleged that "staff left residents in soiled urine/feces resulting in a rash." "Staff providing residents the same plate the dog eats from." During the tour of the faciltity.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Antonine Richard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2023

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-20230808094356

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: IVY PARK AT SANTA MONICA	FACILITY NUMBER: 198204069
	VISIT DATE: 08/16/2023

NARRATIVE

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Allegation staff left residents in soiled urine/feces resulting in a rash.
Allegation staff providing residents the same plate the dog eats from.

LPA interviews revealed the following: Ten (10) out of sixty six (66) Residents (R1-R10) were interviewed all of them stated they like living here. R1-R10 stated never have any problem with staff providing care when they need it. The staff are great when it comes to taking care of them. LPA interviewed ten (10) out seventy six (76) staff (C1-C10) none of them witnessed residents in soiled urine/feces resulting in a rash.

Allegation staff providing residents the same plate the dog eats from. LPA Richard and administrator Villaruz interviewed the kitchen staff C1 on how they wash the dishes. The staff demonstrated how they wash the dishes. First the staff washes the plate with soap then put it on the commercial dishwasher for a second wash and sanitize.

Based on the information collected, record reviews and interviews, the Department found no evidence to support the allegations mentioned in this complaint. "Staff left resident in soiled urine/feces resulting in a rash" "Staff providing residents the same plate the dog eats from".

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur. Therefore the allegations are unsubstantiated.

No deficiency was cited during this visit.

An exit interview was conducted with Judith UY-Villaruz, and a copy of this report was provided.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Antonine Richard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2023

LIC9099 (FAS) - (06/04)

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