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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198204069
Report Date: 12/27/2023
Date Signed: 12/27/2023 03:33:23 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
12/20/2023 and conducted by Evaluator David Espana
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20231220152313
FACILITY NAME:IVY PARK AT SANTA MONICAFACILITY NUMBER:
198204069
ADMINISTRATOR:VILLARUZ, JUDITH UYFACILITY TYPE:
740
ADDRESS:1312 15TH STTELEPHONE:
(310) 899-1976
CITY:SANTA MONICASTATE: CAZIP CODE:
90404
CAPACITY:100CENSUS: 70DATE:
12/27/2023
UNANNOUNCEDTIME BEGAN:
08:58 AM
MET WITH:Administrator, Judith Uy-Villaruz TIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Licensee did not provide notice of rate change to resident.
Licensee is overcharging resident for services.
Licensee did not provide resident with itemized list of fees.
INVESTIGATION FINDINGS:
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On 12/27/2023 at 8:45 am Licensing Program Analyst (LPA) David España conducted a subsequent complaint investigation at the above facility to address the following allegations due to needs further investigation of control number 11-AS-20231220152313.

LPA España met with Executive Director Judith Uy-Villaruz and explained the purpose of this visit was to deliver findings to control number 11-AS-20231220152313 complaint. Upon arrival at the facility, LPA España conducted a risk assessment at the facility entrance. Based on the assessment, the facility is not clear of Covid-19 infection. The investigation consisted of the following: during today's visit, LPA with Executive Director Judith Uy-Villaruz confirmed positive cases at the facility as of 12/27/2023. It has been determined that there are a total Seven (7) out of Seventy (70) residents still positive with COVID-19. LPA reviewed and received from the Administrator the COVID 19 community tracker as of 12/27/2023 at 9:00 am. EVALUATION REPORT CONTINUES ON LIC 9099-C

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David EspanaTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 12/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2023
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 4
Control Number 11-AS-20231220152313
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: 12/27/2023
NARRATIVE
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LPA interviewed Seven (7) out of Seventy (70) residents in person. LPA interviewed Seven (7) out of Seventy-One (71) staff in person. LPA interviewed Seven (7) out of Seventy (70) residents in person who could not confirm the date when they were advised of COVID-19 present at the facility. LPA confirmed with the Administrator that the facility reported COVID-19 cases on 12/22/2023 to CCLD. Per interview with the Administrator, there was no need to report cases to CCLD due to no outbreak. LPA confirmed with the Administrator that as of 12/21/2023 there has been only Seven (7) total positive cases active out of the Nineteenth (19) residents that were positive at the facility. LPA confirmed with the Administrator that as of 12/27/23 there were Seven (7) quarantine. Per the Administrator the precaution or quarantine guidelines are that the 6th day if a person does not show fever (symptoms) they, the person who was positive may come outside of quarantine, however, must be masked for Ten (10) days per guidelines. LPA confirmed with the Administrator that there are Twenty-Two (22) out of Seventy-One (71) staff member currently working at the time of visit.

The investigation revealed the following: Licensee did not provide notice of rate change to resident.
Details provided indicated the facility did not provide notice of rate change to resident. LPA interviewed Seven (7) out of Seventy (70) residents in person. LPA interviewed Seven (7) out of Seventy-One (71) staff in person. LPA interviewed the Administrator who stated that on 11/01/2023, 48 letter were sent out about the rate change (i.e., only). LPA confirmed that 04/27/2023 a letter was sent out about change of ownership from Sunrise to Ivy Park at Santa Monica. LPA interviewed Seven (7) out of Seventy (70) residents in person who confirmed a letter was received, the monthly basic rate would increase by 10% (i.e., monthly fee increases of 10%) as of “January 1, 2024.” Per interview with the Administrator and letter it is due to “normal operating expenses,” “retaining high-performing team members,” and “increases in operational expenses.” Additionally, the letter stated that the reasoning for increasing was “higher utility and transportation costs, and increases in employees' wages and benefit expense.” LPA confirmed with the Administrator there was an advance or written notice provided to all residents in care as of 12/27/2023 relating to monthly rate. LPA also confirmed with the Administrator “Sunrise Increases in Fees and Charges. The Community shall increase the Base Fee in Exhibit 2 on January 1 of each year. Notice of any increase in the fees listed in Exhibit 1, will be provided to the Resident in writing sixty (60) days prior to the effective date of the increase and will state the reason for the increase and a general description of the additional costs.” LPA interviewed Seven (7) out of Seventy (70) residents in person confirmed that they knew the facility was under new ownership. REPORT CONTINUES ON LIC 9099-C
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David EspanaTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 12/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 11-AS-20231220152313
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: 12/27/2023
NARRATIVE
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LPA noted with the Administrator “The Resident will pay all applicable new or increased fees and charges, unless the Resident terminates this Agreement in accordance with Section V” under Sunrise resident agreement. LPA with the Administrator also confirmed that “A change in the level of service (for example, a change from Basic Assisted Living Services to Assisted Living Plus) is not considered a change of fees or charges” which was written by the Sunrise resident agreement. Based on the evidence; documents reviewed, and interviews conducted the finding is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation of, did or did not occur; therefore, the complaint investigation of the allegation is unsubstantiated.
No Deficiencies cited under California Code of Regulations Title 22
Exit Interview Conducted.
A copy of this report was discussed and left with the Administrator Judith Uy-Villaruz whose signature on this form confirm receipt of these documents.
The investigation revealed the following: Licensee is overcharging resident for services.
Details provided indicated the facility does overcharge resident for services. LPA interviewed Seven (7) out of Seventy (70) residents in person. LPA interviewed Seven (7) out of Seventy-One (71) staff in person. LPA interviewed the Administrator who stated that letters were sent out to residents. Per the “Ivy Park at Santa Monica” it revealed that “Each year, we anticipate increases in our normal operating expenses due to the cost of retaining high-performing team members and increases in operational expenses. Due to the increase in year-over-year costs, we are implementing a monthly fee increase of 10%.” LPA noted that the resident agreement does show service fees. LPA noted that all resident agreements are signed by residents or responsible parties. LPA interviewed Seven (7) out of Seventy (70) residents in person who stated they did receive a letter from Ivy Park at Santa Monica. LPA interviewed Seven (7) out of Seventy-One (71) staff in person who stated the facility did send out letters to residents. Based on the evidence; documents reviewed, and interviews conducted the finding is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation of, did or did not occur; therefore, the complaint investigation of the allegation is unsubstantiated. No Deficiencies cited under California Code of Regulations Title 22
Exit Interview Conducted. A copy of this report was discussed and left with the Administrator Judith Uy-Villaruz whose signature on this form confirm receipt of these documents. REPORT CONTINUES ON LIC 9099-C
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David EspanaTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 12/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 11-AS-20231220152313
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: 12/27/2023
NARRATIVE
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The investigation revealed the following: Licensee did not provide resident with itemized list of fees.
Details provided indicated the facility does not provide itemized list of fees to resident for services. The complainant claims resident #5 (R5) does not have an itemized list of fees.

An interview with Seven (7) out of Seventy (70) residents in person revealed that they signed a Residency Agreement. The Residency Agreement details what is covered under basic services. Any care services are written in Ivy Park at Santa Monica resident agreement and signed by resident. A review of Seven (7) out of Seventy (70) residents Physician’s Report LIC 602A list their capacity for self-care and it is aligned with what is on the Ivy Park at Santa Monica resident agreement. Seven (7) out of Seventy (70) residents are aware of the extra charges listed if any per the Ivy Park at Santa Monica resident agreement and that the facility did not do anything underhanded. An interview with Seven (7) out of Seventy (70) residents all supported the statement and included they do not know any residents being overcharged for unnecessary services. An interview with Seven (7) out of Seventy-One (71) staff in person all verified that each resident goes through an extensive admission process which includes a personal assessment. At the time of agreement signing the resident or the designated representative will review a list of attachments and acknowledgments before the Residency Agreement is signed. LPA interviewed Seven (7) out of Seventy-One (71) staff in person all confirmed there are no residents in this facility that is being charged for superfluous services. LPA interviewed Seven (7) out of Seventy-One (71) staff in person explained the care services at this facility is not in a set package; rather, it is offered in a separate item(s) based on the resident’s service assessment and these services are listed on the Ivy Park at Santa Monica resident agreement with monthly prices. Based on the evidence; documents reviewed, and interviews conducted the finding is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation of, did or did not occur; therefore, the complaint investigation of the allegation is unsubstantiated.
No Deficiencies cited under California Code of Regulations Title 22
Exit Interview Conducted.
A copy of this report was discussed and left with the Administrator Judith Uy-Villaruz whose signature on this form confirm receipt of these documents.
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David EspanaTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 12/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4