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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320242
Report Date: 08/07/2024
Date Signed: 08/07/2024 03:27:12 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
07/18/2024 and conducted by Evaluator Elvira Gonzalez
COMPLAINT CONTROL NUMBER: 11-AS-20240718110821
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:150; 150CENSUS: 78DATE:
08/07/2024
UNANNOUNCEDTIME BEGAN:
07:33 AM
MET WITH:Lilia Rodriguez, Resident Care CoordinatorTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff did not respond to resident’s requests for assistance in a timely manner.
Staff did not assist resident with mobility needs following a fall.
Licensee does not ensure sufficient staffing to meet residents’ care needs.
INVESTIGATION FINDINGS:
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On 08/07/24, Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced subsequent complaint visit to conclude investigating the allegations listed above and deliver findings. LPA met with Resident Care Coordinator, Lilia Rodriguez, and the purpose of the visit was explained.

The investigation consisted of the following: On 07/24/24, LPA received copies of the Staff Roster, Resident Roster, and employee schedules for the month of July 2024. LPA interviewed residents #1-#2 (R1-R2), and staff #1-#5 (S1-S5). On 08/07/24, LPA interviewed residents #3-#7 (R3-R7) and attempted to interview staff #6-#8 (S6-S8). Furthermore, LPA along with MemoryCare Coordinator, Jessica Navarro, conducted a tour of the facility.


Continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Elvira GonzalezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024
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-20240718110821
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: 08/07/2024
NARRATIVE
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The investigation revealed the following:

Allegation: Staff did not respond to resident’s requests for assistance in a timely manner. It is alleged that a resident fell on the floor and was left unattended for a couple of hours. It is also alleged that a resident did not receive assistance from staff at their scheduled time, and when assistance was requested from staff using their pendant there was no response. On 07/24/24, LPA interviewed S1-S5. 5 out of 5 staff stated that they frequently check on their residents, and always go to them when the resident calls for them. On 07/24/24, LPA interviewed R1-R2, and on 08/07/24, LPA interviewed R3-R7. 6 out of 7 residents interviewed stated that staff checks on them promptly when needed. 6 out of 7 residents interviewed stated they are satisfied with the services being provided to them at this facility.

Based on LPA observations and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated.

Allegation: Staff did not assist resident with mobility needs following a fall. It is alleged that after a resident fell, they called the front desk but there was no answer, and the resident then left a message. It is also alleged that the resident was left on the floor until the fire department arrived, then after fire department left, the resident was moved to a toilet chair and was left there. It is also alleged that staff refused to move the resident from the toilet chair to their bed using the Hoyer lift, so the resident sat in the toilet chair all night until AM shift assisted the resident to their bed. On 07/24/24 LPA interviewed Business Office Director, Armida Uchiyama (S1), and she stated that the resident had advised her of them falling, and that no one came to assist them. The resident told her that when someone finally came to them, they did not pick them up. Business Office Director, Armida Uchiyama stated she told the resident that that is their protocol, and that staff must make sure an EMT tells them resident is fine before moving them. She stated that this resident is a two-person assist and has a Hoyer lift. The resident told her that staff did not know how to use the Hoyer lift. She said she advised the resident that staff is trained, but the resident insists that they do not know how to use the Hoyer lift to their liking.

Continued on LIC9099-C
SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Elvira GonzalezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20240718110821
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: 08/07/2024
NARRATIVE
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On 07/24/24 LPA interviewed S1-S5. 3 out 5 staff interviewed revealed that no resident was left unassisted after a fall. LPA asked staff if a resident was left on a toilet chair all night on 07/4/24. 2 out 5 staff interviewed said no, and 3/5 staff interviewed said they did not know. On 07/24/24 LPA interviewed R1-R2, and on 08/07/24 LPA interviewed R3-R7. LPA asked residents if they were aware of a resident falling and staff not assisting them. 6 out of 7 residents interviewed stated that they were not aware of a resident falling and staff not assisting them after. LPA asked residents if they knew if a resident was left on a toilet chair all night on 07/4/24. 6/7 residents interviewed said they did not know.

Based on LPA observations and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated.

Allegation: Licensee does not ensure sufficient staffing to meet residents’ care needs. It is alleged the night shift (NOC) at the facility only has one staff to assist the residents because caregivers regularly call out. On 07/24/24 LPA interviewed S1-S5. 3 out 5 staff interviewed revealed that this facility has sufficient staff to meet the resident’s care needs. On 07/24/24 LPA interviewed R1-R2, and on 08/07/24 LPA interviewed R3-R7. 6 out of 7 residents interviewed stated that this facility has sufficient staff to meet their care needs. 6 out of 7 residents interviewed stated they are satisfied with the services being provided to them at this facility.

Based on LPA observations and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated.


No deficiencies cited during today's visit.


An exit interview was held with Executive Director, Brittney Buchannan, and a copy of this report has been provided.
SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Elvira GonzalezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3