198320242-6-20-2022-11-AS-EMAZ-CK6VPY-20221013163730

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320242
Report Date: 06/20/2022
Date Signed: 06/20/2022 04:10:36 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
MONTERY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/10/2022 and conducted by Evaluator Stephanie Cifuentes

COMPLAINT CONTROL NUMBER: 11-AS-20220610100634

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: 85	DATE:	06/20/2022
		UNANNOUNCED	TIME BEGAN:	11:05 AM
MET WITH:	Brittney Bucchanan		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff spoke inappropriately to resident
Staff will not itemize resident's bill
Staff handled resident on a rough manor
Staff are discriminating against resident
Staff will not call or email the authorized representative back
Wrongful Eviction

INVESTIGATION FINDINGS:

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On 6/20/2022 Licensing Program Analyst (LPA) Stephanie Cifuentes conducted an unannounced subsequent complaint investigation at the facility listed above. LPA spoke with Executive Director Brittney Bucchanan, to conduct covid-19 risk assessment. Facility is currently clear of covid-19 infections. LPA arrived at facility and was greeted by staff. LPA explained the purposed of the visit was to investigate the allegations listed above and was granted entry.

The investigation consisted of the following:
On 6/15/2022 LPA Cifuentes conducted a tour of facility grounds and reviewed facility files. LPA requested and received the following documents: Resident roster, Staff roster and other records relevant to the investigation. LPA interviewed staff #1-#4 (S1-S5) and resident #1-#7(R1-R7). On 6/20/2022 LPA Cifuentes spoke to witnesses #1-#2(W1-W2).

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2022

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 4

Control Number 11-AS-20220610100634

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
MONTERY PARK, CA 91754

FACILITY NAME: IVY PARK AT CULVER CITY	FACILITY NUMBER: 198320242
	VISIT DATE: 06/20/2022

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:
Allegation: Staff spoke inappropriately to resident
It is alleged that staff spoke rudely to resident while giving them a shower. LPA spoke to administrator Brittney Bucchanan who stated she has not received any reports of staff speaking to a resident inappropriately. LPA spoke with residents (R1-R7) regarding the allegation. Of those interviewed, six out of seven residents stated staff do not speak inappropriately to them with one not being able to answer due to their diagnosis. LPA spoke with staff (S1-S4) regarding allegations. Of the staff questioned, four out of four there have been no issues with staff speaking inappropriately to resident. LPA also interviewed witnesses (W1-W2) and both stated there were no issues with staff speaking inappropriately to resident. Based on information gathered, the department did not find sufficient evidence to support allegation the allegation.

Allegation: Staff will not itemize resident's bill
It is alleged that staff will not break down what care needs means on resident’s bill. LPA reviewed admissions agreement, section B of which states that facility will provide residents with personal assistance and care on an as needed basis, services of which include bathing, grooming, personal hygiene, and sting, medication management, assistance with ambulating, toileting and transferring, assistance with incontinence and dementia care. Per Beatriz Martinez, breakdown of resident’s needs are discussed with families when a new plan of care is created and a change of care is billed. LPA also spoke to Amrida Uchiyama, Business Office Director, who stated that Ivy Park bills are itemized by item but it’s not specific, dates will not be there, and neither will the level of care. LPA spoke with residents (R1-R7) regarding the allegation. Of those interviewed, two stated that bill was itemized while the other five were unsure as they did not handle the bill. LPA spoke with staff (S1-S4) regarding allegations. Of the staff questioned, two out of four stated residents bill are itemized while the other two did not know. Based on information gathered, the department did not find sufficient evidence to support allegation the allegation.

Continued on 9099-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 11-AS-20220610100634

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
MONTERY PARK, CA 91754

FACILITY NAME: IVY PARK AT CULVER CITY	FACILITY NUMBER: 198320242
	VISIT DATE: 06/20/2022

NARRATIVE

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Allegation: Staff handled resident on a rough manor
It is alleged that facility staff bathed a resident roughly. LPA spoke with administrator Brittany Bucchanan, who stated she had not received any reports that residents had been handled in a rough manner. LPA reviewed staff roster found that staff named in complaint is not employed by facility. LPA spoke with residents (R1-R7) regarding the allegation. Of those interviewed, six out of seven residents stated staff do not handle them roughly with one not being able to answer due to their diagnosis. LPA spoke with staff (S1-S4) regarding allegations. Of the staff questioned, four out of four stated staff do not handle residents roughly. LPA interviewed witnesses (W1-W2) regarding the allegations and one out of two stated they saw a staff handle a resident roughly. Based on information gathered, the department did not find sufficient evidence to support allegation the allegation.

Allegation: Staff are discriminating against resident
It is alleged that staff are discriminating against resident. LPA spoke with administrator, who stated that absolutely no allegations had been made to her about discrimination, that the residents loved the caregivers and the facility has a very diverse community. LPA spoke with residents (R1-R7) regarding the allegation. Of those interviewed, six out of seven residents stated staff do not discriminate against them, with one not being able to answer due to their diagnosis. LPA spoke with staff (S1-S4) regarding allegations. Of the staff questioned, four out of four stated tstaff do not discriminate against residents. LPA also interviewed witnesses (W1-W2) and one felt residents were being discriminated while the other did not. Based on information gathered, the department did not find sufficient evidence to support allegation the allegation.

Allegation: Staff will not call or email the authorized representative back
It is alleged that staff would not respond via email or call when asked a question by residents authorized representative. LPA reviewed emails from facility, where they answer questions asked by residents’ authorized representatives. While one response did take some time, all others were prompt. LPA spoke with residents (R1-R)7 regarding the allegation. Of those interviewed, three said staff were prompt in replies to emails or calls, and three did not know, and one not being able to answer due to their diagnosis. LPA spoke with staff (S1-S4) regarding allegations. Of the staff questioned, four out of four stated they believed facility answered calls or emails by authorized residents promptly with one staff adding that if research was required, it might take longer to respond. Based on information gathered, the department did not find sufficient evidence to support allegation the allegation

Continued on 9099-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20220610100634

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
MONTERY PARK, CA 91754

FACILITY NAME: IVY PARK AT CULVER CITY	FACILITY NUMBER: 198320242
	VISIT DATE: 06/20/2022

NARRATIVE

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Allegation: Wrongful Eviction
It is alleged that a new physician’s agreement has not been completed since 2021, so it should not have been used as the basis for an eviction. LPA reviewed eviction notice for resident R8, which does not name physicians assessment as basis for evaluation, but observation of the resident in the facility. LPA spoke with residents (R1-R7) regarding the allegation. Of those interviewed, six out of seven residents stated they had not been served eviction notices, with one not being able to answer due to their diagnosis. LPA spoke with staff (S1-S4) regarding allegations. Of the staff questioned, three out of four stated they are aware of a resident’s eviction and that it was due to the residents behavior. Based on information gathered, the department did not find sufficient evidence to support allegation the allegation.

The Department’s investigation consisted of an inspection of the facility, observation, analysis of facility records and interviews conducted and found no evidence to support the allegations: “Staff spoke inappropriately to resident,” “Staff will not itemize resident's bill,” “Staff handled resident on a rough manor,” “Staff are discriminating against resident,” “Staff will not call or email the authorized representative back,” “Wrongful Eviction”
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, a copy of this report left with Brittney Bucchanan.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2022

LIC9099 (FAS) - (06/04)

Page: 4 of 4