198603715-5-1-2025-28-AS-WSHO-DGY7UF-20250523215812

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603715
Report Date: 05/01/2025
Date Signed: 05/01/2025 01:15:18 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
04/30/2025 and conducted by Evaluator Noemi Galarza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250430084256

FACILITY NAME:	IVY PARK AT SAN MARINO		FACILITY NUMBER:	198603715
ADMINISTRATOR:	SANCHEZ, KIMBERLY		FACILITY TYPE:	740
ADDRESS:	8332 HUNTINGTON DRIVE		TELEPHONE:	(626) 292-7800
CITY:	SAN GABRIEL	STATE: CA	ZIP CODE:	91775
CAPACITY:	74	CENSUS: 61	DATE:	05/01/2025
		UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Kimberly Sanchez, Executive Director		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Staff did not allow resident in care to communicate with their family member.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Galarza conducted an initial 10-Day complaint visit to investigate the allegation listed above. The purpose of the visit was explained to Executive Director Kimberly Sanchez.

The investigation consisted of: LPA toured the Memory Care Unit and Assisted Living was conducted. Residents (R1- R7), staff (S1- S6), and two (2) family members were interviewed. Resident (R1's) file was reviewed. Copies of R1's Face Sheet, Physician's Report, Appraisals, Power of Attorney, Advance Health Care Directive, staff roster, and resident roster were obtained. No health and safety concerns were observed.

**See page 2.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025

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-20250430084256

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 SAN MARINO	FACILITY NUMBER: 198603715
	VISIT DATE: 05/01/2025

NARRATIVE

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Allegation: Staff did not allow resident in care to communicate with their family member. It is alleged resident (R1's) family member has attempted to contact the resident but has not been allowed to speak to R1 because staff are following a directive given to staff by the resident's authorized representative. The complaint alleges the resident recently moved in to the facility's memory care unit, and other family members were not aware of the move. Once another of R1's family member learned of the move, they allegedly called the facility requesting to speak to the resident, but the calls were not transferred. A total of seven (7) residents were interviewed, of which all denied the allegation. They stated that they receive phone calls from family without any issues. Resident (R1) stated they speak to family members on the phone. A total of six (6) staff were interviewed, of which all denied the allegation. Staff stated that R1's family member made a call to the facility on April 28, 2025, with the purpose of reporting that staff were not allowing the family member to speak to the resident. Only one (1) staff had knowledge of the supposed calls. The staff member stated last week there was one occasion in which a family member called the facility, and was told to call back because the memory care resident was taking a nap. Therefore, the family member was not able to speak to the resident at the time of the call. Per staff interviews, all residents have access to outside callers. There are 2 communal phones in the memory care unit in which they may receive phone calls. In addition, the resident rooms have land line phone capability if families wish to open a public phone line. Administration staff stated that there are are instances where a call comes in for a memory care resident, but the resident(s) may be bathing, napping, eating, or having a behavior and the caller is asked to call back at a later time., but usually staff make an immediate effort to get the resident to the phone. All staff stated they have never prevented anyone from speaking to R1 or visiting the resident. Record review indicates R1 has a Durable Power of Attorney and there is no written document and/or restraining order in place that would prohibit staff from allowing any family member access to R1 telephonically or in-person. There is insufficient evidence to corroborate the allegation.

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.

An exit interview was conducted and a copy of this report was discussed and provided to Executive Director Kimberly Sanchez.

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Noemi Galarza
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025

LIC9099 (FAS) - (06/04)

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