198320431-5-16-2025-11-AS-RORN-DHBMV6-20250604095614

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320431
Report Date: 05/16/2025
Date Signed: 05/16/2025 04:34:19 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
05/02/2025 and conducted by Evaluator Wendy Gibbs

COMPLAINT CONTROL NUMBER: 11-AS-20250502132635

FACILITY NAME:	IVY PARK AT PALOS VERDES		FACILITY NUMBER:	198320431
ADMINISTRATOR:	JOSE SALDANA		FACILITY TYPE:	740
ADDRESS:	25535 HAWTHORNE BLVD.		TELEPHONE:	(310) 377-7425
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90505
CAPACITY:	115	CENSUS: 71	DATE:	05/16/2025
		UNANNOUNCED	TIME BEGAN:	08:58 AM
MET WITH:	Joe Saldana		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Licensee does not ensure that there are enough staff to meet the needs of residents in care.

INVESTIGATION FINDINGS:

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On 05/16/2025, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced Complaint Visit to the facility listed above. LPA met with Administrator, Joe Saldana, and the purpose of today’s visit was explained. LPA was granted entry into the facility.
The investigation consisted of the following:
During today’s visit LPA, interviewed Staff S3, interviewed Residents R2-R8, interviewed Residents Responsible Party W2, and received documents pertinent to the investigation. The following documents were received and reviewed Physician’s Reports for five (5) residents, Individualized Service Plan for five (5) residents, and Assessments for five (5) residents.
During a subsequent visit conducted on 05/09/2025 LPA inspected the facility, interviewed Staff S1, S2, and S4-S11, interviewed a residents Responsible Party W1, and received documents pertinent to the investigation. The following documents were received and reviewed: Staff Roster, Staff Schedule, Resident Roster, Admission Policies, Plan of Operation for dementia Special Care, Job Descriptions, Positions/Work Hours/Shifts, Senior Living Resident Assessment Detail, and Resident Admission Agreement.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2025

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-20250502132635

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 PALOS VERDES	FACILITY NUMBER: 198320431
	VISIT DATE: 05/16/2025

NARRATIVE

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The investigation revealed the following:
Allegation: Licensee does not ensure that there are enough staff to meet the needs of residents in care.
The allegation alleges that staff have left and there are not enough staff to meet the needs of residents.
During the facility inspection, LPA observed four (4) care providers, and the Activity Director working in the fourth floor Memory Care Unit, four (4) care providers working in the third floor Memory Care Unit, and four (4) care providers working on the Assisted Living floors. Additionally, LPA observed two (2) medication technicians working. LPA observed staff assisting residents to the rest room, during activities, escorting to meals, and assisting with eating.
During record review, LPA received and reviewed the facility’s Staff Schedule from April 27, 2025, through May 17, 2025. LPA observed on the AM shifts, 6 AM to 2 PM, there are 4 Care Providers in Assisted Living, 3 Care Providers in the Memory Care Unit on the 3rd floor, 4 Care Providers in the Memory Care Unit on the 4th floor, 2 Med Techs, and 1 LVN. LPA observed on the PM shifts, 2 PM to 10 PM, there are 4 Care Providers in Assisted Living, 3 Care Providers in the Memory Care Unit on the 3rd floor, 4 Care Providers in the Memory Care Unit on the 4th floor, 2 Med Techs, and 1 LVN. LPA observed on the NOC shifts, 10 PM to 6 PM, there are 2 Care Provider in Assisted Living, 2 Care Providers in Memory Care 3rd floor, 2 Care Providers in Memory Care 4th floor, and 1 Med Tech. The Health Service Director (S3), who is an LVN, is scheduled to work Sunday through Thursdays from 9 AM to 5 PM. During review of the Positions/Work Hours/Shifts, LPA observed The Health Service Director is on call and available 24/7.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20250502132635

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 PALOS VERDES	FACILITY NUMBER: 198320431
	VISIT DATE: 05/16/2025

NARRATIVE

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During interviews with Staff S1-S11, were asked if they feel there are enough staff on each shift to meet the needs of residents, eleven (11) out of eleven (11), stated yes there is enough staff to meet the needs of residents. Additionally, Staff S1-S11 were asked how many resident’s care providers are assigned to assist during their shift, ten (10) out of eleven (11) stated care providers are assigned five (5) to seven (7) residents to assist.
During interviews with Residents R2-R8, were asked if they feel there is enough staff on each shift to assist residents with care needs, six (6) out of seven (7) stated yes, there is enough staff on each shift to assist residents with care needs. Additionally, during interviews with Residents R2-R8, were asked if they receive assistance when needed, seven (7) out of seven (7) stated yes, they received assistance when needed.
During interviews with Resident’s R9 and R10’s Responsible Party W1 and W2, were asked if there is enough staff on each shift to meet the needs of residents, two (2) out of two (2) stated yes, there is enough staff to meet the needs of residents.
During the course of the investigation, LPA was unable to find evidence to support the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

During today’s visit, LPA did not observe or cite any deficiencies.

An exit interview was conducted with Executive Director, Joe Saldana, and a copy of this report was provided.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2025

LIC9099 (FAS) - (06/04)

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