198320242-6-9-2022-11-AS-EMAZ-CHW2Q9-20220902173534

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320242
Report Date: 06/09/2022
Date Signed: 06/09/2022 06:06:53 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
05/25/2022 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20220525083132

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:	06/09/2022
		UNANNOUNCED	TIME BEGAN:	09:08 AM
MET WITH:	BRITTNEY BUCHANNAN		TIME COMPLETED:	02:19 PM

ALLEGATION(S):

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Unlawful eviction.
Resident being left in soiled diapers.

INVESTIGATION FINDINGS:

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On 06/09/22 Licensing Program Analyst (LPA) Ernand Dabuet conducted an initial complaint investigation for the allegations listed above. Today’s complaint investigation was conducted with Brittany Buchanan, Executive Director.

The investigation consisted of interviews and record reviews. A review of the following documents: Resident roster, Staff roster, Face sheets, ID/Emergency, Individual Personal Plan, Medical Progress Notes, Medication Administration Records, Admissions Agreement, House Rules, Eviction Notice, ADL's Plan, Employee Mandated training, and other pertinent documents associated with resident #1 (R1). On 06/02/22 and 06/09/22, LPA Dabuet interviewed residents #1-#8 (R1-R8), witnesses #1-#3 (W1-W3), and staff #1-#5 (S1-S5). A tour of the facility was conducted.

Evaluation Report continues on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022

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-20220525083132

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: IVY PARK AT CULVER CITY	FACILITY NUMBER: 198320242
	VISIT DATE: 06/09/2022

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Unlawful eviction.

The details for the complaint stated an unlawful eviction was served to resident #1 (R1). The complainant claimed an eviction was provided to (R1) on a 30-day Notice on 05/19/22 and that this facility is no longer able to provide services to (R1). The complainant said the eviction is unfair, but it does not consider for the eviction to be unlawful.

The complainant expressed the eviction had to do with two staff members staff #2 and #3 (S2-S3). However, the complainant when asked about the two staff members and why she felt they are the core cause for the eviction, the complainant was uncertain/or did not know why she had mentioned the staff by names for this complaint. An interview with the Executive Director (S1) stated that this was not the first eviction served to (R1). A prior eviction notice dated 03/24/22 was served to (R1) and (R1’s) conservator. The order was rescinded after a meeting with all concerned parties and a mutual agreement was established. (R1’s) conservator hired a one-on-one private caregiver for (R1) to assist with (R1’s) wandering and/or eloping from the facility.

According to (S1), alongside the wandering/or eloping, (R1's) behavior impacts their ability to provide the services that she requires, and her behavior violates the house rules. (R1) requires a higher level of care that assisted living is unable to provide. In an interview with residents, #1 and #2 (R1-R2) both denied having any knowledge of residents being evicted unlawfully. An interview with New Horizon Home Health Case Manager witness #2 (W2) confirmed that (R1) is more suited and would benefit in an environment that will provide higher level of care. Interviews with (S1-S5) were aware a Notice of Eviction had been served to (R1). Service records for (R1) were reviewed along with other pertinent documents associated with (R1’s) eviction, which revealed the facility is within Title 22 Regulations and Requirements. Community Care Licensing Department (CCLD) Regional office was notified in a written request and followed the proper procedures. (CCLD) approved the Eviction Notice on 06/02/22. Based on the information gathered, there is no evidence to corroborate the allegation mentioned above.

Evaluation Report continues on LIC 9099-C

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20220525083132

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: IVY PARK AT CULVER CITY	FACILITY NUMBER: 198320242
	VISIT DATE: 06/09/2022

NARRATIVE

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Allegation: Resident being left in soiled diapers.

The complainant alleges resident #1 (R1) is left in soiled diapers and that the staff failed to assist with her incontinence care. The complainant admitted she did not observe (R1) in soiled diapers during her visits and did not have demonstrative evidence. The complainant states she was informed by witnesses that (R1) is not being assisted properly while in care. In an interview with (R1), she stated the staff assists her daily with her incontinence care. However, she is uncertain if she was ever neglected with soiled diapers or clothing. In an interview with (R2), a companion to (R1) claimed he has not observed (R1) with soiled diapers for an extended period. (R2) claimed he will assist with her care or will dispatch staff for assistance. The investigation revealed that (R1) is being assisted with (ADLs) by New Horizon Health weekly. Witness #2-#3 (W2-W3) both reported they have not observed (R1) in soiled diapers for an extended period. (W2-W3) alleges the staff assisting (R1) are aggressive in their approach and which causes (R1) anxiety and acts out in a combative behavior with staff. Nonetheless, (W2-W3) did not have names of staff affiliated with the accusation. An interview with staff #2-#3 (S2-S3) who are named in this complaint denies the allegation. (S1-S4) reported that (R1) is monitored every two hours and that staff are trained professionals on how to handle residents with unacceptable behaviors. Interviews with residents #3-#8 (R3-R8) claimed they had no knowledge of residents neglected with incontinence care. (R3-R6) had kind comments about staff and felt the facility continues to provide residents with safe, healthful, and comfortable accommodations. Based on the information gathered, there is no evidence to support the allegation mentioned above.

Based on information, an inspection of the facility, observation, analysis of (R-1)'s service records, Notice of Eviction, and interviews conducted, the Department found no evidence to support the allegations listed on this complaint report.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations, did or did not occur, therefore the allegations are Unsubstantiated.

An exit interview was conducted with Brittney Buchanan and a copy of the report was provided.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 06/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2022

LIC9099 (FAS) - (06/04)

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