374604455-1-23-2024-08-AS-DPOL-D2224B-20240131160341

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604455
Report Date: 01/23/2024
Date Signed: 01/23/2024 03:47:26 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/22/2024 and conducted by Evaluator Ramon Serrano

COMPLAINT CONTROL NUMBER: 08-AS-20240122104916

FACILITY NAME:	IVY PARK AT OTAY RANCH		FACILITY NUMBER:	374604455
ADMINISTRATOR:	CALAIS ANGUIANO		FACILITY TYPE:	740
ADDRESS:	1290 SANTA ROSE DRIVE		TELEPHONE:	(619) 779-7400
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91913
CAPACITY:	137	CENSUS: 110	DATE:	01/23/2024
		UNANNOUNCED	TIME BEGAN:	09:39 AM
MET WITH:	Calais Anguiano		TIME COMPLETED:	03:59 PM

ALLEGATION(S):

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Facility staff were not adequately trained.
Facility staff mismanaged the residents' medications.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced complaint visit to deliver findings on the above allegations. LPA met with Executive Director Calais Anguiano and we discussed the purpose of the visit and elements of the complaint.

Community Care Licensing (CCL) has investigated the above allegations. The investigation consisted of LPA direct observation, records review and interviews with facility staff.

It was alleged that facility staff mismanaged resident medications and were not adequately trained. It was reported to CCL that med-techs lack proper medication administration training. It was also reported that facility staff are not properly documenting when the residents medications are unavailable. LPA reviewed the training file of three random facility staff members. Staff 1's (S1) training file was reviewed. S1 shadowed another facility staff and completed the following tasks from 11/5/23-11/9/23; 3 hours of "QMAR" videos, using a bubble pack card, reading the labels, measuring liquid medicines, administering and documenting PRN meds,

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Ramon Serrano	TELEPHONE: (619) 458-2583
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 08-AS-20240122104916

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: IVY PARK AT OTAY RANCH	FACILITY NUMBER: 374604455
	VISIT DATE: 01/23/2024

NARRATIVE

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ordering meds and ordering replacement doses for dropped or damaged pills. S1 was also observed conducting med pass and administering meds on 11/7/23-11/13/2023 and the training records were signed and dated.

Staff 2 (S2) training file was reviewed. S2 completed the following medication training; 8 hours of initial medication training, live 4 hour med-tech on boarding training and 16 hours of hands on shadow training, signed and dated on 9/25/2023. The following tasks were completed and observed by a supervisor on 9/25/2023; hand washing, pouring per the 6 rights, crushing medications, eye drops, ear drops, inhalers, nebulizer etc.

Staff 3 (S3) training file was reviewed. S3 completed the following; 12 hours of Relias medication courses dated 8/2/2022-8/17/2022, 10 hours of medication training on 8/22/2022 and completion of the California RCFE medication training on 11/16/2022.

LPA reviewed the medication records of three random residents. Resident 1 (R1) records revealed R1 receives their medications through a non-contracted medical group. Facility records included over seven faxed medication requests to R1's pharmacy dated 11/29/2023 through 12/5/2023. R1 was also included on the "medication refill log" indicating R1's medication name, pharmacy, staff that ordered the medication and date.

Resident 2 (R2) medication records revealed R2 receives their medication through the contracted pharmacy. Medication orders dated 1/15/24 reveal R2's medications are refilled on monthly cycle.

Resident 3 (R3) medication records revealed R3 receives their medication through the contracted pharmacy. Medication orders dated 1/15/24 reveal R3's medications are refilled on monthly cycle.

Interview with S1 revealed they have worked at the facility since October 2023 as a Med-Tech. Prior to working at the facility S1 worked as a Pharmacy technician for seven years. S1 feels properly trained in the area of medication, including; med-pass, emergency services, wound care, hospice, reporting incidents, etc. S1 stated that S1 assists other staff members with refills of medication since S1 is knowledgeable in that area.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Ramon Serrano	TELEPHONE: (619) 458-2583
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 08-AS-20240122104916

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: IVY PARK AT OTAY RANCH	FACILITY NUMBER: 374604455
	VISIT DATE: 01/23/2024

NARRATIVE

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Interview with S2 revealed S2 has worked at the facility since September 2023 as a Lead Med-Tech. S2 stated that S2 feels properly trained. S2 has a Bachelors degree in Biology and Public Health. S2 stated that S2 has alot of experience and knowledge in the area of medication and regularly assists other staff members with refills of medication. S2 stated that the hire of the Health Services Director has made a dramatic improvement.

Interview with Health Services Director (HSD) revealed they have worked at the facility for four months. HSD stated that the biggest issue in the facility was the Resident Care Coordinator (RCC) who was terminated 3 weeks ago. HSD stated that in the past four months HSD has made improvements in oversight in the med room, implementing policy, making sure policies are being followed and overall "culture change" in the facility. HSD further stated that the Regional Specialist conducted an audit in both med rooms and the entire clinical department on November 2023 and the facility scored 96% which is the highest the facility has ever scored.

Interview with Executive Director (ED) revealed they have worked at the facility since June 2023. ED stated that she encountered many problematic issues due to the poor performance of the RCC. ED stated that it was brought to her attention that medication refills were not being processed in a timely manner as well as other facility issues. ED stated that after hiring the HSD she has seen alot of improvement. The HSD has created new audit tools and new communication logs for refills.

Based upon the foregoing, the above listed allegations are unsubstantiated. This finding means that the preponderance of the evidence standard has not been met and the allegations are not valid.

An exit interview was conducted with Calais Anguiano. A copy of this report along with licensee rights (LIC 9058, 3/22) was provided to Calais Anguiano whose signature below verifies receipt of these rights.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Ramon Serrano	TELEPHONE: (619) 458-2583
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024

LIC9099 (FAS) - (06/04)

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