374604455-7-27-2023-08-AS-LTEZ-CUA4YP-20230731193128

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604455
Report Date: 07/27/2023
Date Signed: 07/27/2023 03:52:38 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, 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
09/08/2021 and conducted by Evaluator Rebecca A Ruiz

COMPLAINT CONTROL NUMBER: 08-AS-20210908164827

FACILITY NAME:	IVY PARK AT OTAY RANCH		FACILITY NUMBER:	374604455
ADMINISTRATOR:	WILLIAMS, REBECCA		FACILITY TYPE:	740
ADDRESS:	1290 SANTA ROSE DRIVE		TELEPHONE:	(619) 779-7400
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91913
CAPACITY:	137	CENSUS: 91	DATE:	07/27/2023
		UNANNOUNCED	TIME BEGAN:	01:55 PM
MET WITH:	Executive Director Calais Anguiano		TIME COMPLETED:	03:50 PM

ALLEGATION(S):

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Licensee did not protect residents in care
Staff did not treat resident with dignity

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced complaint visit to conduct follow up and deliver findings regarding the above-mentioned allegations. LPA identified herself to, was greeted by, and explained the purpose of the visit to Executive Director Calais Anguiano. During today’s visit, LPA observed residents in care and interviewed staff and the Executive Director.

The Department’s investigation consisted of interviews with residents, staff, and outside sources, records review, and a tour of the facility. It was alleged that staff did not treat resident with dignity and the Licensee did not protect residents in care. Review of physician’s report for Resident 1 (R1) revealed that R1 had a diagnosis of dementia, was confused and disoriented, and was able to follow directions and make their needs known. R1’s physician’s report did not indicate any wandering, Sundowning, or aggressive behaviors.

Continued on LIC9099-C page...

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A Ruiz	TELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023

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 08-AS-20210908164827

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: IVY PARK AT OTAY RANCH	FACILITY NUMBER: 374604455
	VISIT DATE: 07/27/2023

NARRATIVE

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Review of the physician’s report for Resident 2 (R2) revealed that R2 had a diagnosis of dementia, was confused and disoriented, had a history of inappropriate behaviors, was able to communicate needs, and required assistance with all activities of daily living. Interviews revealed that R2 had Sundowning behaviors and was a fall risk.

Review of the facility’s roster and interviews with staff revealed that R1 and R2 shared a room together in the facility’s memory care for a period of less than six months. Interviews revealed that the facility would assess residents upon move in and consider their likes and dislikes, behaviors, and personality when determining which residents would be good roommates. Interviews with staff and outside sources revealed that R1 had difficulty sleeping at night, had a history of wandering around the common areas, and would sometimes sleep on furniture in common areas. R1 was also known to pace around their room at night which would sometimes wake R2 up. Interviews with staff revealed that staff would attempt to redirect R1 by offering food or asking R1 to sit with them in common areas and that R1 would begin wandering shortly after being redirected back to their room. Interviews revealed that staff contacted R1’s physician to address R1’s trouble sleeping and R1’s medications were changed multiple times. Interviews did not reveal any evidence that R1 was not allowed to enter their shared room by staff or that staff told R1 to sleep on a couch in the common areas instead of in their bed. Interviews with outside sources revealed that around September 2021, R2 stated that R1 had pushed them and that the alleged instance was unwitnessed by staff or other residents. Interviews with staff revealed that sometimes other residents would start physical altercations with R1. Interviews revealed that staff would redirect and separate residents when they engaged in altercations. Interviews revealed that R1 and R2 did not get along well and R2 had a history of yelling at others to leave the facility due to R2’s beliefs that the facility was their home. Interviews with staff revealed a possibility that R2 had yelled at R1 but were unable to confirm any instances. Interviews revealed that R1 was relocated to a different room in the memory care a few days after the pushing allegation was made by R2.

The Department has investigated the above-mentioned allegations and based on interviews and records review, the preponderance of the evidence has not been met, therefore, these allegations are deemed unsubstantiated.

An exit interview was conducted with Executive Director Calais Anguiano, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 01/16).

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A Ruiz	TELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:	DATE: 07/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023

LIC9099 (FAS) - (06/04)

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