198320242-1-5-2024-11-AS-MVAO-CZCUWJ-20240110145650

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320242
Report Date: 01/05/2024
Date Signed: 01/05/2024 04:39:50 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 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
12/28/2023 and conducted by Evaluator Socorro Leandro

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20231228153902

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: 82	DATE:	01/05/2024
		UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Armida Uchiyama		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Facility staff does not assist residents after falling.

INVESTIGATION FINDINGS:

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On 01/05/2024 at around 8:20 AM Licensing Program Manager (LPM) Ulysses Coronel and Licensing Program Analyst (LPA) Socorro Leandro initiated a complaint investigation regarding the allegation listed above. LPA and LPM meet with Business Manager Armida Uchiyama and Executive Director Brittney Buchannan and the purpose of the visit was explained.

The investigation consisted of the following: During today’s investigation LPM, LPA, and S1 conducted a tour of the facility which included activity areas, dining areas, and random resident bedrooms. LPM and LPA also interviewed 8 out of 82 residents and 8 staff. LPM and LPA reviewed facility plan of operation, 4 resident records, and 4 staff records.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro Leandro	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2024

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-20231228153902

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: IVY PARK AT CULVER CITY	FACILITY NUMBER: 198320242
	VISIT DATE: 01/05/2024

NARRATIVE

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The investigation revealed the following: Regarding the allegation "Facility staff does not assist residents after falling" it is being alleged that facility calls first responders for every slip and fall and would leave residents on the floor until first responders arrive. During the tour the team observed a total of 8 staff in the memory care unit and that signal systems are in place inside resident bedrooms, and common areas. 8 out of 8 staff interviews indicate that residents are immediately assessed for injuries and are provided assistance after falls. Staff also indicated that the facility will immediately call 911 for memory care residents who suffer un-witnessed falls to ensure that memory care residents receive a professional medical assessment since they are not able to articulate if they are in pain due to their medical condition. 6 out of 8 resident interviews indicate that residents get helped whenever they need it and like the way they are being treated by staff. 2 out of 8 residents were not able to provide interviews due to their medical condition. Record reviews indicate that the facility conducted an in-service training on 11/16/2023 about Fall Management Protocol which included safety measures that the facility is taking to reduce the risk of resident falls and reporting procedures for staff. Regarding the allegation "Facility staff does not assist residents after falling" The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the allegation is unsubstantiated.

No deficiencies were cited. An exit interview was conducted. A copy of this report was provided to Memory Care Director Jessica Navarro.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro Leandro	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 01/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/05/2024

LIC9099 (FAS) - (06/04)

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