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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601662
Report Date: 05/03/2024
Date Signed: 05/03/2024 03:47:00 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 CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/13/2024 and conducted by Evaluator Noemi Galarza
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240213083741
FACILITY NAME:IVY PARK AT SAN MARINOFACILITY NUMBER:
198601662
ADMINISTRATOR:KIMBERLY SANCHEZFACILITY TYPE:
740
ADDRESS:83332 HUNTINGON DRTELEPHONE:
(626) 292-7800
CITY:SAN GABRIELSTATE: CAZIP CODE:
91775
CAPACITY:74CENSUS: 56DATE:
05/03/2024
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Kimberly Sanchez, Executive DirectorTIME COMPLETED:
03:50 PM
ALLEGATION(S):
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Staff inappropriately handled a resident during showering.
Staff did not ensure safe keeping of a resident's personal items.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Galarza conducted a subsequent complaint investigation visit regarding the above allegations. LPA discussed the purpose of the visit with Executive Director Kimberly Sanchez.

The investigation consisted of: On 2/16/2024, a physical plant tour of the common areas of the facility, with special focus on the Memory Care Unit signal, pendant, and pager system. Staff (S1- S6), residents (R1-R3), and family (F1-F2) were interviewed. Resident (R1's) file was reviewed, and the following documents were reviewed/obtained: Face Sheet, Admission Agreement, Physician's Report, Individual Service Plan (ISP), Home Health Agency Care Notes, Shower Schedule, Lifeline Fall Detection Pendant Instructions, LIC 500 Personnel Report, and resident roster. During today's visit, several resident pendants were tested to ensure they are operable. Additional, residents (R4- R6) were interviewed. No health and safety concerns were observed.

***Narrative continued on LIC9099C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi GalarzaTELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024
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 2
Control Number 28-AS-20240213083741
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 CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: IVY PARK AT SAN MARINO
FACILITY NUMBER: 198601662
VISIT DATE: 05/03/2024
NARRATIVE
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Allegation: Staff inappropriately handled a resident during showering. The complaint alleges that when resident (R1) is provided shower assistance by staff they treat the resident in a mean manner when other staff are not around, and the shower time is rushed. A total of five (5) care staff were interviewed, of which four (4) staff denied the allegation. Interviews revealed that most Memory Care resident showers take approximately 20-30 minutes to be showered. Per interviews, caregiver staff are not given time limits when showering the residents because it is based on resident behaviors i.e. some residents may be slower to get into the shower chairs, others do not want to be in the shower too long because they get cold, and some residents refuse assistance. None of the staff interviewed reported observing other staff treat the Memory Care residents in a mean manner during shower assistance time. Per record review, resident (R1) receives stand-by shower assistance. Staff stated that R1 takes a while to scrub themselves and is hard of hearing. Therefore, the staff's tone of voice may be construed as being treated in a mean manner that may be presumed as verbal impatience. A total of six (6) Memory Care residents with mild cognitive decline were interviewed, of which only (1) stated they are treated with disrespect during shower time. Two (2) of resident (R1's) family members were interviewed and both stated that they have never heard staff act inappropriately towards R1. They also reported that R1 liked to take long 1-hour showers prior to their recent move into this assisted living facility. There is insufficient evidence to corroborate the allegation.


Allegation: Staff did not ensure safe keeping of a resident's personal items. The complaint has concerns that resident (R1's) razors and pillow cases are missing from the resident's room. A review of resident (R1's) file documents shows that R1 has a diagnosis of Dementia. All staff interviewed denied the allegation and stated they are aware of R1's accusation of stolen items. According to staff interviews, Memory Care residents are not supposed to have valuables in their room. However, staff stated that resident (R1) likes to keep their wallet with cash in their room. Staff also reported that the resident often forgets where they place their cell phone and wallet, and tells staff that someone stole their wallet, but it is usually found in the resident's walker. The resident moved in to the facility in early February 2024, and upon move-in staff removed R1's razors for safety reasons. None of the residents in the Memory Care unit are allowed to keep sharp objects like razors in their room, only electric shavers are allowed. Resident (R1) has two (2) electric shavers in their room cabinet that is kept locked. Staff stated that the resident gets bothered when the electric shaver get locked. None of the staff had knowledge of missing pillowcases, but did say that R1 has accused staff of stealing things like soda and razors. Both family members interviewed acknowledged understanding that sharp objects must be locked, and also said that the resident has the alleged missing pillowcases. A total of six (6) Memory Care residents were interviewed, of which only resident (R1) reported issues with their personal belongings.

Based upon interviews and records reviewed, the findings indicate that 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.
Exit interview was conducted with Executive Director Kimberly Sanchez. A copy of the report was issued.
SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi GalarzaTELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024
LIC9099 (FAS) - (06/04)
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