198320242-2-23-2024-11-AS-UCOL-D35SGM-20240307125208

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320242
Report Date: 02/23/2024
Date Signed: 02/23/2024 04:28:05 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 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
12/07/2023 and conducted by Evaluator Regina Cloyd

COMPLAINT CONTROL NUMBER: 11-AS-20231207115841

FACILITY NAME:	IVY PARK AT CULVER CITY		FACILITY NUMBER:	198320242
ADMINISTRATOR:	BRITTNEY BUCHANNAN		FACILITY TYPE:	740
ADDRESS:	4061 GRAND VIEW BLVD.		TELEPHONE:	(949) 744-5200
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90066
CAPACITY:	150	CENSUS: 82	DATE:	02/23/2024
		UNANNOUNCED	TIME BEGAN:	08:17 AM
MET WITH:	Business Office Director Armida Uchiyama		TIME COMPLETED:	04:40 PM

ALLEGATION(S):

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Facility is in disrepair.

INVESTIGATION FINDINGS:

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On 02/23/2024 Licensing Program Analyst (LPA) Regina Cloyd conducted a complaint investigation at the above facility to address the following allegation(s).

LPA met with Business Office Director Armida Uchiyama and explained the purpose of the visit. LPA met with Administrator Brittney Buchannan later in the day. The investigation consisted of the following: During today’s visit, LPA toured (11) resident rooms, interviewed 13 out of 82 residents, interviewed 8 staff which included the Administrator, Business Office Director, MedTech, Maintenance Assistant, Concierge and (3) Care Providers,and reviewed records.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) -40-7397
LICENSING EVALUATOR NAME: Regina Cloyd	TELEPHONE: 323-981-7155
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024

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-20231207115841

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: IVY PARK AT CULVER CITY	FACILITY NUMBER: 198320242
	VISIT DATE: 02/23/2024

NARRATIVE

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The investigation revealed the following: Regarding the allegation "Facility is in disrepair". It is being alleged that residents’ fireplaces in their bedrooms are in disrepair. Interviews conducted indicated the following: 4 out of 13 residents interviews disagreed with the allegations and indicated that the gas has been cut off due to fire hazardous, 7 out of 13 residents hasn’t heard complaints about residents’ fireplaces being in disrepair, 1 out of 13 residents was unsure if the fireplace discussion was a complaint, and 1 out of 13 residents stated that the gas was cut off and has heard of one fireplace in disrepair complaint. Staff interviews conducted indicated the following: 4 out of 8 staff members have not heard residents complain about fireplace being in disrepair and 4 out 8 staff members have heard of one fireplace complaint and indicated that the gas was cut off. During the facility tour, LPA saw fireplaces in 3 out of 11 residents’ room. One fireplace on the first floor lit up and two fireplaces on the second floor did not light up. One resident verbally indicated that the fireplace did not work due to the gas being turn off, but the LPA was unable to view her room. The facility sketch and price sheet indicates that room rates are based on layout styles. The Administrator stated that fireplaces are not an additional charge. LPA reviewed six admission agreements and did not see fireplace charges. Regarding the allegation “Facility is in disrepair," based on observations, interviews, and record reviews, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, as a result, the allegation is Unsubstantiated.

No deficiencies were cited. An exit interview was conducted and a copy of this report was reviewed and left with the Business Office Director Armida Uchiyama.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) -40-7397
LICENSING EVALUATOR NAME: Regina Cloyd	TELEPHONE: 323-981-7155
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024

LIC9099 (FAS) - (06/04)

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