275202358-11-29-2023-24-AS-BCHN-D3GV8K-20240318161251

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 275202358
Report Date: 11/29/2023
Date Signed: 11/29/2023 11:04:13 AM

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
10/02/2023 and conducted by Evaluator David Ayers

COMPLAINT CONTROL NUMBER: 24-AS-20231002100859

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: 92	DATE:	11/29/2023
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Kellie Shearer - Executive Director		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Staff are not meeting residents needs

INVESTIGATION FINDINGS:

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On 11/29/2023, Licensing Program Analyst (LPA) D. Ayers conducted an unannounced complaint inspection. LPA met with Executive Director Kellie Shearer and announced the purpose of the visit. The purpose of this visit is to deliver the finding of the investigation completed by the Department. LPA conducted a tour of the facility, interior and exterior to ensure there are no potential or immediate health and safety risk at the facility.
-Staff are not meeting residents needs-
During facility inspection on 10/5/2023, there were 11 caregivers, 3 medication technicians, and a program coordinator on duty and able to provide direct care to residents. Residents were observed to be participating in planned activities in the memory care section of the facility. Medications appeared to be properly administered. Resident bedrooms and bathrooms wer clean and generally free from odor. Facility administrator provided records of staff training, which was California Code of Regulations, Title 22 requirements. A sample of residents whom were interviewed stated that they were satisfied with the care they were receiving at the facility. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated. A copy of the report was provided and exit interview conducted.

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: 11/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2023

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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