198320242-8-15-2024-11-AS-UCOL-DEXSVP-20250320141301

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320242
Report Date: 08/15/2024
Date Signed: 08/15/2024 02:06:12 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, 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
08/06/2024 and conducted by Evaluator Jose Calderon

COMPLAINT CONTROL NUMBER: 11-AS-20240806154717

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: 83	DATE:	08/15/2024
		UNANNOUNCED	TIME BEGAN:	09:42 AM
MET WITH:	MANAGER ARMIDA UCHIYAMA		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Facility staff do not respond to call buttons in a timely manner
Facility staff does not serve nutritious meals.
Resident's barking dog is interfering with daily living of other residents
Licensee does not ensure the facility has an active Director on site

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to Ivy Park at Culver City facility on 08/15/2024 and was greeted by Manager Armida Uchiyama (S1). LPA Calderon spoke to S1 prior to entering the facility to conduct a risk assessment. LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations.

During this investigation, LPA Calderon interviewed staff S1-S5 and interview residents R1- R8. LPA Calderon obtained and reviewed the following records: Physician Report (dated 02/07/2022), Individual Service Plan (ISP) (dated 06/20/2024), Admission agreement (date 10/01/2021), Physician Orders (date 04/05/2021), Call log report (date July-August 2024), Meal Plan (July 2024) for R1.

The investigation revealed the following:

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024

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-20240806154717

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 CULVER CITY	FACILITY NUMBER: 198320242
	VISIT DATE: 08/15/2024

NARRATIVE

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Regarding Allegation 1: Facility staff do not respond to call buttons in a timely manner.

This complaint alleged that staff did not respond to R1 pushing the call button in a timely manner. LPA Calderon toured the facility and noted staff providing services to residents. LPA Calderon noted staff interacting with residents, making lunch, and helping with resident’s care needs. Records indicate the following: Individual Service Plan (ISP) (date 06/20/2024). No health issues noted for resident. Reviewed call button logs (date July – August 2024), R1 pressed the button many times and the wait time was between 3 minutes to 32 minutes. 5 out of 5 staff indicate that there is a 10-to-15-minute wait time for resident that push the call button. 6 out of 8 residents indicate a 5-to-10-minute wait time for pushing the call button for service.

Regarding Allegation 2: Facility staff does not serve nutritious meals.

This complaint alleged that staff did not serve meals that taste good. Toured the facility to include the dining room around lunch time. LPA noted a daily menu and monthly meal plan. Food appeared to look and smell fine. 5 out of 5 staff indicate that the kitchen staff serve nutritious meals to residents. 6 out of 8 residents indicate that the food could be better, but they have no issues with the food served.

Regarding Allegation 3: Residents barking dog is interfering with daily living of other residents.

This complaint alleged that R3 dog barks and interferes with other residents daily living. LPA toured the facility. LPA visited R3 room and noted small dog in a cage. Dog was not barking or making a sound. Knocked on R1 room door and noted there was no issue with dog barking. LPA knocked on other doors no one was home. Reviewed admission agreement for R1. Animals are allowed by the facility. 5 out of 5 staff indicate that the small dog does bark, but no resident has complained except R1. 6 out of 8 residents have no issues with dog or dog barking.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 11-AS-20240806154717

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 CULVER CITY	FACILITY NUMBER: 198320242
	VISIT DATE: 08/15/2024

NARRATIVE

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Regarding Allegation 4: Licensee does not ensure the facility has an active director on site.

This complaint alleged that there is staffing issues and no director that works the night shift. LPA Calderon toured the facility and noted many staff working and taking care of residents needs. Reviewed the staff roster and noted a mix of day and night staff shifts for the facility. S1 indicates that S1 works until 10 pm and residents can find S1 in S1 office. 5 out of 5 staff indicate no staffing issues for day and night shifts. 6 out of 8 residents indicate that there are no staffing issues for the night shift.

Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has NOT been met; therefore, the allegations of “Facility staff do not respond to call buttons in a timely manner”, “facility staff does not serve nutritious meals”, “residents barking dog is interfering with daily living of other residents”, “licensee does not ensure the facility has an active director on site” is found to be UNSUBSTANTIATED.

No deficiencies cited during today's visit.

An exit interview was conducted and copy of the Complaint Report were provided to the Manager Armida Uchiyama (S1)

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2024

LIC9099 (FAS) - (06/04)

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