275202358-8-10-2023-24-AS-BCHN-D2PNJK-20240222093024

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 275202358
Report Date: 08/10/2023
Date Signed: 08/10/2023 12:16:48 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 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 David Ayers

COMPLAINT CONTROL NUMBER: 24-AS-20230807142430

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:	Kellie Shearer - Executive Director		TIME COMPLETED:	12:40 PM

ALLEGATION(S):

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Staff do not properly maintain a resident's room while in care

INVESTIGATION FINDINGS:

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On 8/10/2023, Licensing Program Analysts (LPA's) D. Ayers and S. Hurt conducted an unannounced complaint inspection. LPA's met with Executive Director Kellie Shearer and announced the purpose of the inspection.

LPA's conducted a tour of the facility, interior and exterior to ensure there are no potential or immediate health and safety risk at the facility.

During the course of the investigation, the department conducted inspections, conducted interviews, and reviewed records. LPA's inspected residents' rooms and to verify that they were clean and odor free. LPA's reviewed records of room checks and cleaning schedules. Based on the interviews conducted, documentation obtained and reviewed, and the information received during this investigation, the preponderance of evidence standard has not been met; therefore, the above allegation is found to be unsubstantiated at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: David Ayers	TELEPHONE: 559-498-4163
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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