198320242-9-17-2025-11-AS-UCOL-DMAVQG-20251009163818

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320242
Report Date: 09/17/2025
Date Signed: 09/17/2025 03:04:06 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
09/12/2025 and conducted by Evaluator Jose Calderon

COMPLAINT CONTROL NUMBER: 11-AS-20250912104950

FACILITY NAME:	IVY PARK AT CULVER CITY		FACILITY NUMBER:	198320242
ADMINISTRATOR:	BRITTNEY BUCHANNAN		FACILITY TYPE:	740
ADDRESS:	4061 GRAND VIEW BLVD.		TELEPHONE:	(310) 390-0565
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90066
CAPACITY:	150	CENSUS: 83	DATE:	09/17/2025
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	ADMINISTRATOR TIRRE THORNTON		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not respond to resident's calls for assistance in a timely manner
Staff did not provide resident's responsible party with written notice of rate increase

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 09/17/2025 Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to Ivy Park at Culver City facility and was greeted by Administrator Tirre Thornton (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.
The investigation consisted of the following: LPA Calderon interviewed Administrator S1, Staff S2-S5, resident R1-R9. LPA Calderon obtained the following records: Needs and Service plan (dated 06/30/2025), Resident Assessment (dated 07/01/2025), Email (dated 05/22/2025), Call button log notes (dated 09/03/2025 to 09/17/2025), Admission Agreement (dated 11/26/2024), Fee Schedule for R1. LPA Calderon toured the facility with S1.
The investigation revealed the following:

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025

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-20250912104950

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: 09/17/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Regarding Allegation #1: Staff do not respond to residents’ calls for assistance in a timely manner.

This complaint alleged that staff did not respond to R1 pressing R1 call button timely. LPA Calderon and S1 toured the facility. LPA Calderon did not notice any negative interactions between staff and residents. LPA Calderon and S1 walked into rooms 104, 205, 225, 305 and pressed the call button. On average it takes 5 minutes for staff to respond to the call button being pushed.

Records indicate the following: The Needs and Service Plan indicate that R1 has cognitive issues and is non-verbal. The call button log notes indicate that staff responded to the call button being pushed 16 times from 09/03/2025 to 09/17/2025 for an average wait time of 8 minutes. The interviews indicate the following: S1-S5 deny the allegation ever happened. R1 is non-verbal and could not answer any questions. 2 out of 9 residents indicate that there is enough staff to take care of residents’ needs, and their call button is answered within 10 minutes.

Based on interviews and supporting documentation, the preponderance of evidence standard has NOT been met therefore, the allegation of “staff did not respond to residents calls for assistance in a timely manner” is found to be UNSUBSTANTIATED.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 11-AS-20250912104950

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: 09/17/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Regarding Allegation #2: Staff did not provide the residents responsible party with written notice of rate increase.

This complaint claimed that staff did not provide written notice of a rate change. LPA Calderon and S1 toured the facility. LPA Calderon did not notice any negative interactions between staff and residents. Records indicate the following: The Admission Agreement page 4 “personal assistance and care” assigns points to a resident’s care for services. Page 6 “adjustments to fees” or services spell out how and why the facility charges for services. Email between the facility and R1 conservator, regarding the increase in cost of services was noted by LPA Calderon. Email between R1 conservator and the facility dated 05/22/2025 to 09/15/2025. The facility emailed the balance due, and a payment schedule emailed from 06/01/2025 to 09/01/2025, appears total charges $9175.00. A breakdown of the points assigned to R1 was forwarded to R1 conservator. The interviews indicate the following: S1 indicates that on 05/22/2025 S1 emailed a written notice of increased fees based on the admission agreement and the care assessment that was provided to R1 conservator. 2 out of 9 residents indicate that their families take care of the bill for services with the facility.

Based on interviews and supporting documentation, the preponderance of evidence standard has NOT been met therefore, the allegation of “staff did not provide residents responsible party with written notice of rate increase” is found to be UNSUBSTANTIATED.

An exit interview was conducted, and a copy of the Complaint Report was provided to the Administrator Tirre Thornton (S1).

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3