198320242-9-8-2022-11-AS-UCOL-CKBMEG-20221018093239

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320242
Report Date: 09/08/2022
Date Signed: 09/08/2022 03:18:11 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
09/02/2022 and conducted by Evaluator Don Senaha

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20220902143333

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: 80	DATE:	09/08/2022
		UNANNOUNCED	TIME BEGAN:	10:01 AM
MET WITH:	Executive Director - Britteny Buchannan		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Licensee does not ensure that infection control practices are properly maintained.

INVESTIGATION FINDINGS:

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On 09/08/2022 Licensing Program Analyst (LPA) Don Senaha initiated a complaint investigation for the allegation listed above. Today’s complaint investigation was conducted with Executive Director Brittney Buchannan.

The investigation consisted of the following: LPA requested and received resident roster, staff roster and other service documents on 09/08/2022. LPA interviewed residents (R1-R9) and staff (S1-S7).

A plant inspection of the facility was conducted on 09/08/2022.

No deficiencies were found at the time of the visit.

Investigation revealed:

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Don Senaha	TELEPHONE: (323) 629-5133
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022

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-20220902143333

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: 09/08/2022

NARRATIVE

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Allegation: Licensee does not ensure that infection control practices are properly maintained.

During the course of the investigation, LPA was unable to find any witnesses or documentation supporting the allegation above.

LPA interviewed residents (R1-R9) who stated there are no issues with cleanliness of residents’ rooms and bathrooms. Residents (R1-R9) stated there are no cleaning issues after staff has finished cleaning residents’ rooms and bathrooms. LPA interviewed staff (S1-S7) who stated staff are trained on infection control practices through online training (Relias system) and in-service trainings. Staff (S1-S7) stated there is a deep cleaning for the residents’ bathrooms and bedrooms once a week by housekeeping staff. Staff (S1-S7) stated there are no issues with the cleanliness of residents’ bathrooms and bedrooms.

LPA did not observe any issues with infection control practices during visit. LPA observed protocols are in place according to the facility mitigation plan and Infection Control Policies. LPA obtained and reviewed the Infection Control Policies. LPA obtained and reviewed training documents for staff and housekeeping schedule for weekly cleaning of residents’ rooms.

There is no evidence that supports the facility does not ensure that infection control practices are properly maintained.

Based on LPA’s interviews conducted and records reviews, 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 the alleged violations did or did not occur, therefore the allegation is Unsubstantiated.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Don Senaha	TELEPHONE: (323) 629-5133
LICENSING EVALUATOR SIGNATURE:	DATE: 09/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2022

LIC9099 (FAS) - (06/04)

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