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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320242
Report Date: 02/12/2024
Date Signed: 06/14/2024 09:24:09 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, 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
06/12/2023 and conducted by Evaluator Pamela Bunker
COMPLAINT CONTROL NUMBER: 11-AS-20230612114611
FACILITY NAME:IVY PARK AT CULVER CITYFACILITY NUMBER:
198320242
ADMINISTRATOR:BRITTNEY BUCHANNANFACILITY TYPE:
740
ADDRESS:4061 GRAND VIEW BLVD.TELEPHONE:
(949) 744-5200
CITY:LOS ANGELESSTATE: CAZIP CODE:
90066
CAPACITY:150CENSUS: 81DATE:
02/12/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Amber Reynolds and Armi UchiyamaTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Staff did not provide assistance to resident in a timely manner.
Staff not providing adequate food service for resident.
Staff does not provide activities for residents.
Staff does not wear hair nets while cooking and serving food.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Monday, February 12, 2024, Upon arrival at the facility. LPA Bunker called the facility via telephone and conducted a Risk Assessment. Based on the assessment, the facility is cleared of COVID-19 infection. LPA Bunker met Health Services Director Amber Reynolds and Business Office Director Armi Uchiyama. LPA Bunker explained the purpose of today's visit.

The investigation consisted of the following: During the investigation interviews were conducted with staff members (S1-S3) and residents (R1-R8). An inspection of the facility's kitchen was undertaken. During this inspection, it was observed that kitchen staff adhered to hygiene protocols by wearing hair nets. There was an abundance supply of perishable and nonperishable food supplies. The facility's elevator was examined and found to be in optimal operational condition throughout the duration of the visit. LPA Bunker asked pertinent questions that aligned with the nature of the complaint. LPA Bunker requested copies of supporting documents. S1-S3 and R1-R8 denied the allegations. See continued LIC9099-C page 2
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Pamela BunkerTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024
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 3
Control Number 11-AS-20230612114611
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: 02/12/2024
NARRATIVE
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Continued LIC9099-C page 2
Allegation #1: Staff did not provide assistance to residents in a timely manner. LPA Bunker initiated a series of interviews with both staff members (S1-S3) and residents (R1-R8). S1-S3 and R1-R8 all affirm that assistance is provided to residents in a timely manner. R1-R8 all agreed and further articulated their contentment with their living conditions, specifically praising the respect, dignity, and quality of care extended to them. S1-S3 stated the facility staff is providing a secure, healthful, and comfortable living environment. R1-R8 stated they were happy with the care and supervision staff is providing and their individual care needs are being met in a timely manner. S1-S3 and R1-R8 denied the allegation.

Allegation #2: Staff not providing adequate food service for residents. In response to the claim of inadequate food service, interviews were conducted with staff members (S1-S3) and residents (R1-R8) all agreed the facility is providing adequate food service to the residents. The unanimous response from S1-S3 and R1-R8 interviews indicated that residents are provided with three nutritious meals daily, breakfast, lunch, and dinner plus snacks, with options for seconds if desired. Observations confirmed an ample supply of both non-perishable food items for one week and perishable food for two days, effectively dispelling concerns regarding food service adequacy. Staff provided LPA with a copy of the weekly food menus. S1-S3 and R1-R8 denied the allegation.

Allegation #3: Staff does not provide activities for residents. The allegation concerning the absence of activities for residents was thoroughly investigated through interviews with staff (S1-S3) and residents (R1-R8) all agreed, alongside an examination of the facility's activity calendar. S1-S3 and R1-R8 verified the provision of daily activities designed to engage and enrich the lives of those residing in the facility. During the inspection, I during the visit I witnessed residents actively participating in scheduled activities. R1-R8 stated they have a list of activities that they participate in bingo, crossword puzzles, charades, drawing, guessing games, Taboo, chess, brain teasers, board games, word search games, storytelling, exercising, social hours, water coloring, movie night, happy hours, arts and crafts, etc. S1-S3 and R1-R8 denied the allegation.

Allegation #4: Staff does not wear hair nets while cooking and serving food. S1-S3 and R1-R4 stated staff wear hair nets while cooking, and serving food, in the dining room, and kitchen during breakfast, lunch, dinner, and snack times S1-S3 and R1-R8 all agreed, during today's visit I observed staff wearing hair nets while cooking and serving food. S1-S3 confirmed that kitchen staff consistently adhere to food safety practices by wearing hair nets during food preparation and service, thereby maintaining high standards of hygiene and safety. S1-S3 and R1-R8 denied the allegation. See continued LIC812-C page 3

SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Pamela BunkerTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20230612114611
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: 02/12/2024
NARRATIVE
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Continued LIC812-C page 3
Investigation revealed the following: LPA Bunker conducted detailed interviews with staff members (S1-S3) and residents (R1-R8) all agreed, alongside meticulous observations. It was unanimously affirmed by S1-S3 and R1-R8 that staff provides timely and effective assistance to all residents. S1-S3 and R1-R8 stated staff are providing residents with the necessary care and supervision. R1-R8 stated their daily care needs are being met. The feedback highlighted the residents' satisfaction with the level of respect, dignity, and quality of care they receive, alongside their appreciation for the secure, healthful, and comfortable living environment maintained by the facility.

Investigations into the food service operations revealed that the facility provides three nutritious meals daily, supplemented by snacks, with ample provisions allowing for second servings. This dispels any concerns regarding the adequacy of food service, supported by observations of substantial food supplies of nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. LPA Bunker observed the facility's monthly food menu staff is following. Resident's also has food options.

S1-S3 and R1- R8 confirmed the availability of a diverse range of daily activities, aimed at enriching the residents' lives and fostering a vibrant community. This was further corroborated by direct observations of active resident participation. LPA Bunker observed the facility's monthly activity calendar and Daily Chronicle.

LPA observed staff wearing hair nets. S1-S3 and R1-R8 stated staff does wear hair nets while cooking and serving food. Allegations of non-compliance with food safety practices, specifically regarding the use of hair nets by kitchen staff, were found to be without merit. Interviews and direct observations confirmed adherence to stringent food safety standards, ensuring the health and safety of all residents.

S1-S3 and R1-R8 stated staff is providing residents with a safe, healthy, and comfortable environment. R1-R8 stated they get plenty of food to eat, residents participate in daily activities, and staff wear hair nets while cooking and serving food. S1-S3 stated the facility is providing an environment where residents are treated with dignity and respect. S1-S3 and R1-R8 all denied the allegations.

Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the allegation. 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, therefore the allegation is deemed unsubstantiated. A copy of the Complaint Investigation Report LIC9099, and LIC9099-C, was provided to staff. There were no deficiencies cited. Exit interview conducted.
SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Pamela BunkerTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3