275202358-3-8-2024-24-AS-BCHN-D3H24S-20240318170424

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 275202358
Report Date: 03/07/2024
Date Signed: 03/08/2024 04:09:37 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
02/07/2024 and conducted by Evaluator David Ayers

COMPLAINT CONTROL NUMBER: 24-AS-20240207083257

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: 107	DATE:	03/07/2024
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Kellie Shearer - Executive Director		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff did not implement a proper emergency disaster plan

INVESTIGATION FINDINGS:

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On 3/7/2024, Licensng Program Analyst(LPA) D. Ayers arrived unannounced to deliver complaint findings. LPA met with Executive Director Kellie Shearer and Resident Care Coordinator Karina Ramirez and announced the purpose of the inspection. During the inspection, LPA toured the facility, conducted staff and resident interviews, and reviewed records.
Allegation: Staff did not implement a proper emergency disaster plan

Based off of records review, facility emergency disaster plan meets regulatory requirements. During a power outage on the evening of 2/3/2024 and early morning hours of 2/4/2024, the facility generator failed, leaving the facility without emergency lighting. Flashlights and lanterns were provided to staff and residents. 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 with Executive Director, and a copy of the report was provided via email.

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: 03/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2024

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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