306006222-11-3-2023-22-AS-SSAS-D2F2L5-20240213162900

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006222
Report Date: 11/03/2023
Date Signed: 11/03/2023 03:03:58 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/27/2023 and conducted by Evaluator Celine DePerio

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20231027144246

FACILITY NAME:	IVY AT WELLINGTON, THE		FACILITY NUMBER:	306006222
ADMINISTRATOR:	OLSON, KATHLEEN		FACILITY TYPE:	740
ADDRESS:	24903 MOULTON PARKWAY		TELEPHONE:	(949) 458-2311
CITY:	ALISO VIEJO	STATE: CA	ZIP CODE:	92653
CAPACITY:	305	CENSUS: 111	DATE:	11/03/2023
		UNANNOUNCED	TIME BEGAN:	08:37 AM
MET WITH:	Executive Director - Gerry Vadnais		TIME COMPLETED:	02:05 PM

ALLEGATION(S):

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Staff do not answer residents' call buttons in a timely manner
Staff do not ensure residents are bathed

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced 10-day visit to the facility for the complaint received on 10/27/23 and to deliver the findings. LPA De Perio explained the purpose of today's visit, was greeted by executive director (ED) Gerry Vadnais.

During the investigation, LPA De Perio toured the physical plant of the facility, conducted interviews, and requested copies of pertinent records reviewed.

It was alleged that the staff do not answer resident's call buttons in a timely manner. LPA toured random resident rooms and tested the call buttons. LPA observed that staff responded between thirteen to fifteen minutes. LPA conducted a total of 7 interviews that consisted of staff and residents. All 7 interviews did not corroborate with the allegation by stating that although there is an average of a fifteen to twenty minute response period, the staff still responds to the call button.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerio	TELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023

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 22-AS-20231027144246

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: IVY AT WELLINGTON, THE	FACILITY NUMBER: 306006222
	VISIT DATE: 11/03/2023

NARRATIVE

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It was also observed that each facility staff has a radio that is carried around to communicate amongst the other staff to update on a resident's whereabouts are. LPA reviewed the pendant tracking report for the month of October and observed that the average response time was between twelve to twenty three minutes.

It was alleged that staff do not ensure that residents are bathed. LPA observed that the facility tracks a resident's bathing schedule through a bathing log. LPA conducted 3 staff interviews who stated that if a resident declines in wanting to be bathed, not only is it documented, but staff will inform the resident's family of refusal, and depending on the resident's admission agreement, the facility will offer a refund. The 4 interviews conducted with residents stated that there were no concerns regarding bathing because the caregivers do a "good job" at ensuring bathing needs are met.

Based on LPA’s interviews which were conducted, review of documents obtained, and observations, LPA is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed UNSUBSTANTIATED.

An exit interview was conducted with ED Vadnais .

A copy of this report was provided and explained.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerio	TELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023

LIC9099 (FAS) - (06/04)

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