275202849-12-19-2023-24-AS-BCHN-CZZTZS-20240131141048

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 275202849
Report Date: 12/14/2023
Date Signed: 12/19/2023 12:30:52 PM

Substantiated

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
08/18/2023 and conducted by Evaluator Sarah Hurt

COMPLAINT CONTROL NUMBER: 24-AS-20230818095543

FACILITY NAME:	IVY PARK AT SALINAS		FACILITY NUMBER:	275202849
ADMINISTRATOR:	POST, SARA		FACILITY TYPE:	740
ADDRESS:	1320 PADRE DRIVE		TELEPHONE:	(831) 754-5532
CITY:	SALINAS	STATE: CA	ZIP CODE:	93901
CAPACITY:	185	CENSUS: 174	DATE:	12/14/2023
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Administrator, Sara Post		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Facility did not seek medical attention in a timely manner.
Facility did not provide adequate supervision resulting in resident eloping from the facility.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit to deliver findings on the above allegations. LPA met with facility staff Administrator, Sara Post and explained the purpose of today's visit.

Regarding the allegation Facility did not seek medical attention in a timely manner. Resident 1 fell on their bathroom floor on 08/03/2023 at approximately 04:30 a.m. Resident 1 told facility staff they were haivng pain in their legs which caused them to lose balance and fall. Resident 1 was assesed and given medication for pain at the facility. Resident 1 was taken to the hospital at approximately 12:40 p.m., and was diagnosed with a fractured femur. Based on records reviewed, and interviews which were conducted , the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED

Substantiated

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: 12/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023

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-20230818095543

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 SALINAS	FACILITY NUMBER: 275202849
	VISIT DATE: 12/14/2023

NARRATIVE

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Continued..

Regarding the allegation Facility did not provide adequate supervision resulting in resident eloping from the facility. Resident 1 eloped from the facility on 06/30/2023. Facility staff heard the Memory Care area door alarm alert and went to look out the door but did not see any residents outside. Facility staff cleared the alarm. Resident 1 was did leave the facility and was already around the corner out of site, and was eventually recovered down the street. Based on records reviewed, and interviews which were conducted , the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED

The following Deficiencies are being cited Per Title 22 Regulations. Exit interview conducted with Administrator, Sarah Post and a copy of this report along with appeals rights provided.

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sarah Hurt	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 12/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 24-AS-20230818095543

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 SALINAS	FACILITY NUMBER: 275202849
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/14/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 12/15/2023 Section Cited CCR 87465(a)	1 2 3 4 5 6 7	87465 Incidental Medical and Dental Care(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: The following requirement has not been met as evidenced by:	1 2 3 4 5 6 7	Administrator will conduct training with facility staff on timely medical care, and submit proof to LPA by POC date of 12/14/23
	8 9 10 11 12 13 14	Resident 1 was not provided timely medical care as she was provided medical attention 8 hours after the initial fall on 08/03/2023 which poses an immediate health, safety, or personal rights risk to residents in care.	8 9 10 11 12 13 14
Type A 12/15/2023 Section Cited CCR 87705(a)(A)(6)	1 2 3 4 5 6 7	87705 Care of Persons with Dementia(a)This section applies to licensees who accept or retain residents diagnosed by a physician to have dementia. Mild cognitive impairment, as defined in Section 87101(m), is not considered to be dementia(A)Facility staff shall attempt to redirect any unaccompanied resident(s) leaving the facility.(6)Locked exterior doors or perimeter fences with locked gates shall not substitute for trained staff in sufficient numbers to meet the care and supervision needs of all residents. The following requirement has not been met as evidenced by:	1 2 3 4 5 6 7	Administrator will conduct training with facility staff on facility elopemenet policies and procedures, conduct elopement training drills, and submit proof to LPA by POC date of 12/15/23
	8 9 10 11 12 13 14	Resident 1 eloped from the facility on 06/30/2023 which poses an immediate health, safety, or personal rights risk to residents in care.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Brenda Chan	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Sarah Hurt	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2023

LIC9099 (FAS) - (06/04)

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