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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320242
Report Date: 03/17/2025
Date Signed: 03/17/2025 05:10:45 PM

Document Has Been Signed on 03/17/2025 05:10 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 CITYFACILITY NUMBER:
198320242
ADMINISTRATOR/
DIRECTOR:		BRITTNEY BUCHANNANFACILITY TYPE:
740
ADDRESS:4061 GRAND VIEW BLVD.TELEPHONE:
(949) 744-5200
CITY:LOS ANGELESSTATE: CAZIP CODE:
90066
CAPACITY: 150CENSUS: 76DATE:
03/17/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:20 PM
MET WITH:Tierre Thornton- Executive Director TIME VISIT/
INSPECTION COMPLETED:
05:20 PM
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Licensing Program Analyst (LPA) Bernadette Allen and Licensing Program Manager (LPM) Stephanie Cifuentes conducted an unannounced visit to conduct an annual inspection. LPA/LPM were greeted by Tierre Thornton-Executive Director upon arrival. LPA/LPM introduced themselves, explained the purpose of the visit, to Tierre Thornton who granted access into the facility.

The facility has a memory care unit and an assisted living unit; the assisted living unit consist of three floors which includes resident rooms, common area, kitchen, dining area, an outdoor shaded area, a laundry room, reception area and administrative offices. Memory care unit consist of resident rooms, dining area, common area, outdoor activity area and delayed egress doors. The facility has a signal system with the switch board in the reception area and is operational from all resident living units.

At 1:39 PM, LPA/LPM reviewed seven (7) clients files for admission agreements, updated physician reports, and needs and services plans which were up to date.



At 2:37 PM, LPA/LPM and Tierre Thornton- Executive Director toured the physical plant. There were no bodies of water or obstructions on the premises. LPA/LPM inspected a total of seven (7) bedrooms and seven (7) bathrooms. The beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the residents’ personal belongings was observed. The bathrooms were in good condition and operational. Smoke and carbon monoxide detectors were operational. The water temperature ranged from 105°F to 118. °F, and the bedroom temperatures ranged from 72°F to 78°F.

At 3:15, LPA/LPM observed that the facility appeared to be clean, sanitary, and appropriately furnished. Storage areas for personal hygiene were in place. Cleaning supplies, toxins, and sharp objects were stored in a way that made them inaccessible to residents in care. The kitchen was inspected, and there was sufficient perishable and non-perishable food available, which was adequately maintained. All fire extinguishers were charged and operable. The last Fire/Disaster Drills were conducted on 2/4/2025.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE: DATE: 03/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/17/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 03/17/2025
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At 4:15 PM LPA/LPM also reviewed seven (7) staff files for First Aid/CPR certification, criminal record clearance, training's, and health screenings which were all current.

Based on the observations made during today’s visit, no deficiencies were cited.

An exit interview was conducted, and this report was discussed and provided to Tierre Thornton- Executive Director at the conclusion of the visit.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2025
LIC809 (FAS) - (06/04)
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