198602608-9-16-2024-28-AS-LHIS-D9HNN6-20240927103613

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602608
Report Date: 09/16/2024
Date Signed: 09/16/2024 12:06:09 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
08/01/2024 and conducted by Evaluator Jewel Baptiste

COMPLAINT CONTROL NUMBER: 28-AS-20240801132548

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: 135	DATE:	09/16/2024
		UNANNOUNCED	TIME BEGAN:	08:25 AM
MET WITH:	Executive Director Laura Rodriguez		TIME COMPLETED:	12:20 PM

ALLEGATION(S):

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Resident was sexually abused while in care
Staff did not ensure resident had privacy

INVESTIGATION FINDINGS:

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On 09/16/2024, Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced subsequent complaint investigation regarding the above allegation(s). The complaint was also investigated by IB investigator Dennis Douglas. LPA met with Laura Rodriguez, Executive Director (ED) and explained the reason for the visit.

During the visit on 08/01/2024, LPA Baptiste conducted a tour of the facility. The following documents were also obtained for R1: Face Sheet, Physician Report, Level of Care Assessment, Physician’s Order’s, SOC 341, Individualized Service Plan, Admissions Agreement, and Identification and Emergency Information. LPA Baptiste also obtained Staff Roster, Resident

During todays visit LPA Baptiste interviewed a total of 9 resident who shall be referred to as R3 through R11. R1 and R2 was interviewed by IB investigator Dennis Douglas. LPA also interviewed the Administrator and a total of 2 staff who shall be referred too as S1 and S2. LPA obtained a copy of the staff roster and resident roster. (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: 09/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2024

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-20240801132548

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: 09/16/2024

NARRATIVE

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The investigation reveals the following: Regarding “Resident was sexually abused while in care”. It is alleged that R1 was sexually assaulted by R2. The Executive Director (ED) stated this is the second time R1 has made this allegation, and it is during the times the facility has construction. The ED further stated R1 claims R2 lives about their room but R2 lives on the other side of the building. 2 out of 2 staff stated R1 and R2 were friends when R2 first moved in. When R2 started to distance themselves from R1 they noticed R1 started making allegations against R2. Staff further stated that there were other allegations R1 made against R2 but R2 was not around R1. 5 out of 11 residents stated R2 is a nice and respectful person. 4 out of 11 residents stated they don’t know R1 or R2. R1 stated in their interviews with IB investigator that someone in the facility is trying to hurt them but would not elaborate. R2 denied the allegation. LPA reviewed IB’s report from Cerritos College Police department. While the police visited there were thumping noises coming from the ceiling and stated R1 stated R2 was in the room because of those noises. R1 also told the police they were assaulted 3-4 times in the past 4 years but R1 was not living in the facility for 4 years at the time. LPA reviewed R1’s medical records and observed R1 has a diagnosis and a history of dementia and confusion. R1 has since relocated to another facility, needing a higher level of care.

The investigation reveals the following: Regarding “Staff did not ensure resident had privacy”. It is alleged that R2 sprays themselves through R1’s vent and is listening in on R1’s phone conversation. The Executive Director (ED) denied the allegation stating the residents have their privacy and R2 lives on the other side of the building. The ED further stated staff knocks and wait for acknowledgment 3 times before entering the resident’s rooms. 2 out of 2 staff confirmed the ED’s statement. 10 out 11 residents stated they have enough privacy while living in the facility.

Based on LPA's interviews, observation, 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 Laura Rodriguez Executive Director and a copy of this report was provided.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel Baptiste	TELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024

LIC9099 (FAS) - (06/04)

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