275202358-8-21-2023-24-AS-BCHN-D2PNX9-20240222095046

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 275202358
Report Date: 08/10/2023
Date Signed: 08/21/2023 10:55:16 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO ASC, 1314 E SHAW AVE
FRESNO, CA 93710

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/07/2023 and conducted by Evaluator Sarah Hurt

COMPLAINT CONTROL NUMBER: 24-AS-20230807113508

FACILITY NAME:	IVY PARK AT MONTEREY		FACILITY NUMBER:	275202358
ADMINISTRATOR:	SHEARER, KELLIE D		FACILITY TYPE:	740
ADDRESS:	1110 CASS ST		TELEPHONE:	(949) 744-5200
CITY:	MONTEREY	STATE: CA	ZIP CODE:	93940
CAPACITY:	112	CENSUS: 77	DATE:	08/10/2023
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Adminstrator Kelly Shearer		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff improperly restrain a resident in their bed.
Staff do not ensure that a door in the memory care unit is locked.

INVESTIGATION FINDINGS:

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On 08/10/2023, Licensing Program Analysts (LPA's) Sarah Hurt and David Ayers arrived at the facility unannounced to conduct an initial 10-day complaint inspection. LPA’s met with Administrator Kelly Shearer and explained the purpose of this visit.

Regarding the allegation staff improperly restrain a resident in their bed. LPA’S reviewed Resident 1’s hospice care plan which documents the use of “halo” bed rails. LPA’s observed Resident 1’s bed did not have full length bed rails, and only rails on the top which are considered “halo” rails. Based on LPA observation, interviews conducted, and records reviewed this allegation is UNSUBSTANTIATED. A finding that an allegation is Unsubstantiated means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

Continued on 9099C..

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sarah Hurt	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023

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 24-AS-20230807113508

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO ASC, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: IVY PARK AT MONTEREY	FACILITY NUMBER: 275202358
	VISIT DATE: 08/10/2023

NARRATIVE

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...Continued

Regarding the allegation staff do not ensure that a door in the memory care unit is locked. LPA’s observed all doors exiting the memory care area required a code for exit. LPA’s interviewed two facility staff who stated the doors exiting from the Memory Care area are secured at all times, and they are not aware of any times the doors are left propped open. Based on LPA observation, interviews conducted, and records reviewed this allegation is UNSUBSTANTIATED. A finding that an allegation is Unsubstantiated means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

Exit interview conducted with Administrator Kelly Shearer, and a copy of this report provided.

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sarah Hurt	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2023

LIC9099 (FAS) - (06/04)

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