198602608-10-10-2023-28-AS-LHIS-CWQK5Z-20231018073643

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602608
Report Date: 10/10/2023
Date Signed: 10/10/2023 12:02:33 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
09/25/2023 and conducted by Evaluator Jewel Baptiste

COMPLAINT CONTROL NUMBER: 28-AS-20230925081542

FACILITY NAME:	IVY PARK AT CERRITOS		FACILITY NUMBER:	198602608
ADMINISTRATOR:	LILIT CHAPARYAN		FACILITY TYPE:	740
ADDRESS:	11000 NEW FALCON WAY		TELEPHONE:	(562) 865-9500
CITY:	CERRITOS	STATE: CA	ZIP CODE:	90703
CAPACITY:	163	CENSUS: 130	DATE:	10/10/2023
		UNANNOUNCED	TIME BEGAN:	08:34 AM
MET WITH:	Administrator Laura Rodriguez		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Staff did not assist resident with ADLs
Staff did not meet resident's needs

INVESTIGATION FINDINGS:

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On 10/10/23 at 8:34 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted two unannounced complaint visits in-conjunction. Upon arrival LPA was greeted by receptionist and activites director Chelsea Vandueck. The Executive Director Laura Rodriguez arrive at 9:50 and LPA explained the purpose of the visit.

During the initial investigation on 10/03/2023: LPA obtained resident roster, staff roster, R1 admissions agreement, R1’s physicians report, R1’s Hospice plan of care, R1’s resident assessment, R1’s resident information form, R1’s hospice treatment plan, R1’s physicians orders from hospice agency. LPA interviewed: The residential care director and (1) staff who shall be referred to as S1. LPA interviewed a total of ten (10) residents who shall be referred to as: R2 through R11. LPA also interviewed a former resident who shall be referred to as R1. LPA interviewed resident family members and hospice agency who shall be referred to as witness #1 (W1) and witness #2 (W2). LPA is currently waiting on additional documents from an outside agency.
Report continued on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel Baptiste	TELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2023

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 28-AS-20230925081542

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 CERRITOS	FACILITY NUMBER: 198602608
	VISIT DATE: 10/10/2023

NARRATIVE

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During today’s visit LPA interviewed Executive Director Laura Rodriguez and delivered findings for the investigation.

The investigation reveals the following: Regarding " Staff did not assist resident with ADLs.”. It is alleged that the facility does not assist with the residents’ activities of daily living (ADL). LPA interviewed Executive director Laura Rodriguez and Resident Care Director, Martha Altamira, who denied the allegation stating the facility assist’s residents with ADLs. They further stated residents are reassessed every resident quarterly to ensure their needs are met. 1 out of 1 staff stated the facility assists residents with their ADL’s. 8 out of 10 residents stated the facility helps them with their activities of daily living or they do not need assistance with their activities of daily living. 1 out 10 residents stated the facility was not assisting with their activities of daily living. 1 out of 10 residents stated the facility was not assisting ADL’s.

The investigation reveals the following: Regarding " Staff did not meet resident's needs.”. It is alleged that the facility is not meeting the needs of the residents. LPA interviewed Executive Director Laura Rodriguez and Resident Care Director, Martha Altamira, who denied the allegation stating the facility has always met the needs of the residents. 8 out of 10 residents denied the allegation stating the facility has always met their needs. 2 out of 10 residents stated the facility was not able to meet their needs.

Based on LPA's interviews, investigation revealed: 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.

Exit interview conducted with Laura Rodriguez and a copy of this record provided.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel Baptiste	TELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2023

LIC9099 (FAS) - (06/04)

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