198320242-2-23-2023-11-AS-RORN-CPKREJ-20230303115737

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320242
Report Date: 02/23/2023
Date Signed: 02/23/2023 09:26:17 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 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
02/16/2023 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230216162105

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: 78	DATE:	02/23/2023
		UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Amber Reynolds		TIME COMPLETED:	04:04 PM

ALLEGATION(S):

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Staff do not treat resident with dignity or respect.

INVESTIGATION FINDINGS:

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On 02/23/23 Licensing Program Analyst (LPA) Ernand Dabuet conducted an initial complaint investigation for the allegation listed above. LPA was greeted by Health Services Director Amber Reynolds. LPA explained the purpose of today's visit is to investigate the allegation listed above.

INVESTIGATION REVEALED THE FOLLOWING:
It is alleged that resident #1 (R1) is not treated with dignity or respect by staff. The complainant reported when discussing (R1's) accommodation request, staff #1 (S1) described (R1) as an "entitled resident." (S1) stated, "Give them an inch - they take a mile." During an interview with (S1), (S1) identified (R1) as "entitled." (S1) admitted such comments had been made but no malicious intent nor intended to harm (R1). (R2-R8) reported that they are treated with dignity and respect by the staff. According to the information gathered and S1's acknowledgement, this allegation can be corroborated.

(Evaluation Report continues LIC 9099-C)

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2023

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 5

Control Number 11-AS-20230216162105

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: IVY PARK AT CULVER CITY	FACILITY NUMBER: 198320242
	VISIT DATE: 02/23/2023

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	Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has been met; therefore, the allegation of: "Staff do not treat resident with dignity or respect" is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8, is being cited on the attached LIC 9099-D.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 11-AS-20230216162105

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: IVY PARK AT CULVER CITY	FACILITY NUMBER: 198320242
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/23/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/09/2023 Section Cited CCR 87468.1(a)(1)	1 2 3 4 5 6 7	87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidence by:	1 2 3 4 5 6 7	Licensee will develop written plan that Section 87468.1 was reviewed and will comply to the regulations. Proof correction must be sent to LPA by fax by 03/09/23 at 323-981-1781.
	8 9 10 11 12 13 14	Based on observations and interviews conducted, (S1) made inapproriate comments failing to accord (R1) dignity and respect. This is a potential health and safety risk to clients in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 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
02/16/2023 and conducted by Evaluator Ernand Dabuet

COMPLAINT CONTROL NUMBER: 11-AS-20230216162105

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: 78	DATE:	02/23/2023
		UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Amber Reynolds & Armida Uchiyama		TIME COMPLETED:	04:04 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff do not meet the needs of resident in care.

INVESTIGATION FINDINGS:

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

On 02/23/23 Licensing Program Analyst (LPA) Ernand Dabuet conducted an initial complaint investigation for the allegation listed above. LPA was greeted by Health Services Director Amber Reynolds. LPA explained the purpose of today's visit is to investigate the allegations listed above.

Investigation consisted of the following: A review of staff and resident roster. A review of resident # (R1's) service records and other documents in association with this complaint. Interviews conducted with the Executive Director, Health Services Director and Marketing and Sales Director staff #1-#3 (S1-S3), residents #2-#8 (R1-R8). A tour of the facility.

(Evaluation Report continues LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 11-AS-20230216162105

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: IVY PARK AT CULVER CITY	FACILITY NUMBER: 198320242
	VISIT DATE: 02/23/2023

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Staff do not meet the needs of resident in care.
The details of the complaint stated that the staff do not meet resident #1 (R1's) care needs. The complainant reported (R1) had expressed an interest in room #104 on the first floor with staff #1 (S1) on 12/15/22. The complainant stated the request was not honored by (S1) once the room became available on 01/18/23 and was rented to a new resident who was on the waitlist. The complainant felt (R1) was overlooked for this request as (R1) assumed that management did not like (R1). An interview with staff #1-#2 (S1-S2) explained that there is a process. The room that (R1) had an interest in room #104 only became available in February 2023. The former resident provided a 30-day notice in the first week of January 2023, not in December 2022. (R1) found out the room would potentially become available was not from any management staff according to (S1-S2). (S1-S2) claimed room #104 was already spoken for by a new resident who had made a deposit and was on the waitlist. (S1-S2) claimed they had no knowledge that (R1) had expressed interest in room #104. (S2) contends that preferential treatment is not involved. (S1) stated available rooms were offered to (R1) but were refused. According to (S1-S2) this matter has been settled with (R1) and she is currently on the waitlist for room #104 and will have priority over newly admitted residents. Interviews with residents #2-#8 (R2-R8) all had complimentary comments about their services and reported their needs are met by staff.

The details for the complaint mentioned (R1) had requested for consistent staff member assigned to (R1) for showers instead of multiple care staff providing the service. According to staff #1 and #3 (S1-S3), (R1) does require assistance with showers twice a week. (S1) claimed that (R1's) preference for two individual care staff who have left for another employer and the other is injured. ( S1 to S3) are diligently working with (R1) to fulfill this request and ensure that her needs are being met. During interviews with residents #2-#8 (R2-R8), the care staff were described as diligent, hardworking, and responsive. (R2-R8) were comfortable, and the services they received were not problematic. (R1) was out of the community and was not available for an in-person or phone interview. Based on the information provided, the Department finds insufficient evidence to support the allegation mentioned above.

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

An exit interview was conducted with Business Director Armida Uchiyama and a copy of report was provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2023

LIC9099 (FAS) - (06/04)

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