198602608-5-16-2024-28-AS-WSHO-D5GVBM-20240521161746

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602608
Report Date: 05/16/2024
Date Signed: 05/16/2024 03:27:30 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
04/17/2024 and conducted by Evaluator Luis Mora

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240417083844

FACILITY NAME:	IVY PARK AT CERRITOS		FACILITY NUMBER:	198602608
ADMINISTRATOR:	LAURA RODRIGUEZ		FACILITY TYPE:	740
ADDRESS:	11000 NEW FALCON WAY		TELEPHONE:	(562) 865-9500
CITY:	CERRITOS	STATE: CA	ZIP CODE:	90703
CAPACITY:	163	CENSUS: 133	DATE:	05/16/2024
		UNANNOUNCED	TIME BEGAN:	08:51 AM
MET WITH:	Laura Rodriguez - Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff did not ensure that residents were served food free from contamination.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Luis Mora conducted an unannounced subsequent complaint visit regarding the above allegation. LPA met with Martha Altamira (Resident Care Director) and explained the reason for the visit.

The investigation consisted of the following: On 04/18/2024, LPA obtained copies of staff & resident rosters, a Public Health list with names of all residents and staff that got sick, and interviewed Resident Care Director, Staff 1 (S1), and Department of Public Health representatives, and conducted a tour of the kitchen. During today's visit, LPA interviewed Staff 2 - Staff 4 (S2 - S4) and Resident 1 - Resident 12 (R1 - R12), and conducted a tour of the kitchen.

Regarding the allegation: "staff did not ensure that residents were served food free from contamination”, it is alleged that over twenty residents and three staff became sick after they consumed breakfast, lunch and dinner meals served from the facility's kitchen. (Continued to LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024

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 28-AS-20240417083844

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: IVY PARK AT CERRITOS	FACILITY NUMBER: 198602608
	VISIT DATE: 05/16/2024

NARRATIVE

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Administrator believes that residents and staff did not get sick from facility's food. She stated that there was an outbreak and LA County Public Health got involved. LA County Public Health determined that there was a norovirus outbreak based on some stool collected and tested. Administrator stated that their first case was Resident 1 (R1). Resident 1 (R1) vomited in the dining room on 04/08/2024. After this incident, many residents and staff started getting sick. Administrator stated R1 was not showing any symptoms until R1 vomited in the dining room. Administrator believes this incident might have been the beginning of the norovirus outbreak, but LA County Public Health was not able to determined the cause of the norovirus. LPA reviewed the LA County Public Health list of all the residents and staff that got sick and observed a total of 32 residents and 18 staff. R1's date of onset illness was 04/08/2024 and everyone else is either 04/10/2024 or after. The LA County Public Health Nurse assigned to this outbreak stated that the case was assigned to her on 04/11/2024 and it was determined that it was a norovirus outbreak based on test results from some stools they collected. The nurse also stated that unfortunately they were not able to determined the source of this outbreak and this case was closed on 04/25/2024. LPA conducted a tour of the kitchen on 04/18/2024 and today, and did not observed any concerns with the food. Staff interviewed believe they got sick from providing care to the residents that were sick and not from eating the facility's food. Residents interviewed did not provide any information that indicated that the facility's food was the cause of the sickness.

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 held and a copy of the report was provided

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024

LIC9099 (FAS) - (06/04)

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