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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602608
Report Date: 10/10/2023
Date Signed: 10/10/2023 12:04:34 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
03/07/2023 and conducted by Evaluator Jewel Baptiste
COMPLAINT CONTROL NUMBER: 28-AS-20230307090726
FACILITY NAME:IVY PARK AT CERRITOSFACILITY NUMBER:
198602608
ADMINISTRATOR:LILIT CHAPARYANFACILITY TYPE:
740
ADDRESS:11000 NEW FALCON WAYTELEPHONE:
(562) 865-9500
CITY:CERRITOSSTATE: CAZIP CODE:
90703
CAPACITY:163CENSUS: 130DATE:
10/10/2023
UNANNOUNCEDTIME BEGAN:
08:24 AM
MET WITH:Administrator Laura RodriguezTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Facility failed to provide a safe environment for residents
Facility failed to provide a comfortable temperature for residents
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 3/14/2023: A physical plant tour and interviews with staff (S1-S2), and resident (R1-R3). The following documents were obtained: Photo of the thermostats, Staff schedule, admissions agreement, Evacuation order, LIC 500 Personnel Report, and resident roster.

Report continued on 9099c
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Jewel Baptiste
LICENSING PROGRAM ANALYST 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)
Page: 1 of 5
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
03/07/2023 and conducted by Evaluator Jewel Baptiste
COMPLAINT CONTROL NUMBER: 28-AS-20230307090726

FACILITY NAME:IVY PARK AT CERRITOSFACILITY NUMBER:
198602608
ADMINISTRATOR:LILIT CHAPARYANFACILITY TYPE:
740
ADDRESS:11000 NEW FALCON WAYTELEPHONE:
(562) 865-9500
CITY:CERRITOSSTATE: CAZIP CODE:
90703
CAPACITY:163CENSUS: 130DATE:
10/10/2023
UNANNOUNCEDTIME BEGAN:
08:24 AM
MET WITH:Administrator Laura RodriguezTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Facility has insufficient staffing to meet residents’ 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 3/14/2023: A physical plant tour and interviews with staff (S1-S2), and resident (R1-R3). The following documents were obtained: Photo of the thermostats, Staff schedule, admissions agreement, Evacuation order, LIC 500 Personnel Report, and resident roster.

Report continued on 9099c


Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Jewel Baptiste
LICENSING PROGRAM ANALYST 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)
Page: 2 of 5
Control Number 28-AS-20230307090726
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/31/2023
Section Cited
CCR
87411(a)
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(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services.
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The facility will ensure there are sufficent staffing in the kitchen to provide residents meals in a timely manner. Facility Administrator stated they are working on stream lining the kitchen services and hired new kitchen staff. The facility will provide training to all kitchen staff and send training to LPA by POC due date.
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This requirement was not met as evidence by: Based on interviews 8 out of 10 residents stated due to the lack of staff they have had to wait an hour or more for their food, which poses an potential health,safety, or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Jewel Baptiste
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 28-AS-20230307090726
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 seven (7) Residents who shall be referred to as R4 through R10.
The investigation reveals the following: Regarding "Facility has insufficient staffing to meet residents’ needs.”. It is alleged that the facility has a high turnover rate, which led to residents waiting more than an hour for food. The Executive Director at the Time (Lilit Charparyan) denied the allegation stating it has never taken a 1 ½ hours for the residents to receive their food. 2 out of 2 staff denied the allegation. 8 out of 10 residents stated due to the lack of staff they have had to wait an hour or more for their food. 2 out of 10 residents stated they don't eat at the facility or they get there food in 10-15 minutes.

Based on LPA observation, interviews and file review, the preponderance of evidence standard has been met,therefore the above allegations is found to be SUBSTANTIATED. California Code of Regulation, Title 22 are being cited on the attached LIC9099D.

Exit Interview Conducted with Executive Director/ Appeal Rights Provided / A Copy of the Report Issued.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Jewel Baptiste
LICENSING PROGRAM ANALYST 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)
Page: 4 of 5
Control Number 28-AS-20230307090726
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 Eecutive Director Laura Rodriguez and seven (7) Residents who shall be referred to as R4 through R10.

The investigation reveals the following: Regarding Facility failed to provide a safe environment for residents". It is alleged that the facility staff leaves the back door unsecured. Executive Director Laura Roriguez denied the allegation stating the staff ensure they provide a safe environment to the residents and secures the perimeter. The former Executive Director (Lilit Charparyan) denied the allegation stating the facility secures the door after hours. 9 out of 10 residents denied the allegation stating they feel safe. 1 out of 10 residents stated the facility never secures the doors. 2 out of 2 staff denied the allegation stating the back doors are always secured after hours.

The investigation reveals the following: Regarding “Facility failed to provide a comfortable temperature for residents ". It is alleged that the facility is always cold. The Executive Director Laura Rodriguez stated the residents have individual thermostats and staff assists if the residents do not know how to operate the device. The former Executive Director (Lilit Charparyan) denied the allegation, stating residents have individual thermostats in their room that they can adjust themselves. 2 out of 2 staff denied the allegation, stating that the thermostats can be adjusted by the residents. 7 out of 10 residents stated they are fine with the temperature. 1 out of 10 residents stated the facility doesn’t turn on the heating system and the facility is extremely cold. 2 out of 10 residents stated the thermostat was broken and has been repaired. LPA toured the facility and observed the temperature was 77 degrees. LPA also toured residents’ bedrooms and observed their thermostat was between 77-78 degrees.

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.
NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Jewel Baptiste
LICENSING PROGRAM ANALYST 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)
Page: 5 of 5