198602608-1-16-2025-28-AS-RORN-DF5SWC-20250326141407

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602608
Report Date: 01/16/2025
Date Signed: 01/16/2025 03:41:54 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
01/08/2025 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250108095853

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: 140	DATE:	01/16/2025
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Administrator Laura Rodriguez		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff do not observe residents for change in condition
Staff do not assist a resident with grooming
Staff do not answer residents' call buttons in a timely manner
Staff did not provide resident with housekeeping services
Staff did not safeguard a resident's personal belongings

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Villalobos conducted an initial unnanounced complaint investigation visit for the allegation(s) listed above. LPA met with Administrator Laura Rodriguez and the purpose of the visit was discuseed.

During todays visit, LPA conducted the following: Interviewed Staff #1-7 (S1-S7), interviewed residents #1-10 (R1-R10), LPA toured the physical plants which included rooms #'s 160, 173, 177, 203, 234, 264, 275, and 281. LPA also collected and reviewed documents from R1 and R2's files, collected copies of the staff and client roster as well as reviewed and collected records of call button response times. The investigation revealed the following:

Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025

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 3

Control Number 28-AS-20250108095853

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: 01/16/2025

NARRATIVE

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In regards to the allegation "Staff do not observe residents for change in condition", it is alleged that R1 has had changes in their condition not observed and addressed by staff. (7) of (7) Staff interviewed denied the allegation. (10) of (10) Residents interviewed could not corroborate the allegation. Staff interviewed stated that R1 and all residents are observed by staff daily. If there are any concerns of changes in their conditions, it is addressed with medical staff. If needed, individual service plans are also updated. Staff interviewed stated that R1's service plan is current and address their needs and services. R1 was not able to express having any issues with their needs and services. Residents interviewed stated that staff are observant of any health issues regarding the residents. File review of R1's needs and services plan shows to have been last updated on 12/7/24. Based on LPA's interviews, observations, and file review the investigation revealed that ; 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.

In regards to the allegation "Staff do not assist a resident with grooming" it is alleged that there is a resident who walks around in diapers because staff are not meeting their grooming needs. (7) of (7) Staff interviewed denied the allegation. (10) of (10) Residents interviewed could not corroborate the allegation. Interviews did not show there being a resident who walks around the facility in their diaper. Staff interviewed stated that all residents who need grooming assistance will receive it from staff. LPA was not provided further information about any resident who walks around the facility in a diaper. Based on LPA's interviews, observations, and file review the investigation revealed that ; 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.

In regards to the allegation "Staff do not answer residents' call buttons in a timely manner" it is alleged that staff take 30 to 50 minutes to assist R2 when they press their call button. (7) of (7) Staff interviewed denied the allegation. (10) of (10) Residents interviewed could not corroborate the allegation. Staff interviewed stated that R2 is listed as a 2-person assist, meaning there needs to be 2 caregivers available for assisting with mobility when needed. In some instances it may take longer than 10 minutes to get 2 caregivers into R2's room when there are other residents who need assistance as well but it does not take longer than 30 minutes. Residents interviewed did not have issues with the response times of the staff and stated that they arrive in a timely manner. interview with R2 did not state they had issues with the staff response times either. LPA reviewed the call button response times for R2 and observed an average response time of 11 minutes. Based on LPA's interviews, observations, and file review the investigation revealed that ; 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.
Continued on LIC 9099-C

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20250108095853

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: 01/16/2025

NARRATIVE

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In regards to the allegation "Staff did not provide resident with housekeeping services" it is alleged that staff are not cleaning R2's room. (7) of (7) Staff interviewed denied the allegation. (10) of (10) Residents interviewed could not corroborate the allegation. Staff stated that it is facility policy to provide housekeeping services to residents. Rooms are cleaned weekly and any additional assistance can always be requested by the residents. Residents interviewed stated that staff do provide housekeeping services and have no issues with the services. LPA observed housekeeping staff going through residents rooms during the time of the visit. LPA entered R2's room along with other rooms while touring the physical plant and did not observed unattended messes. The facility was clean and in good repair. Based on LPA's interviews, observations, and file review the investigation revealed that ; 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.

In regards to the allegation "Staff did not safeguard a resident's personal belongings" it is alleged that a resident had 70 dollars taken from their room due to lack of supervision. (7) of (7) Staff interviewed denied the allegation. (10) of (10) Residents interviewed could not corroborate the allegation. LPA was not provided with specific information regarding who was the resident who had money missing or who could have taken it. Interviews with staff and residents did not provide any names of an individual having 70 dollars taken from them by either staff or another resident. Interviews with staff stated that any reports of missing or stolen items are investigated and local police is contacted. Based on LPA's interviews, observations, and file review the investigation revealed that ; 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 was conducted with Administrator Laura Rodriguez and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Jose Villalobos
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025

LIC9099 (FAS) - (06/04)

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