374604455-8-28-2023-08-AS-DPOL-CV8RNR-20230831131046

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604455
Report Date: 08/28/2023
Date Signed: 08/28/2023 06:53:42 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
01/25/2022 and conducted by Evaluator Marisela Garcia-Centeno

COMPLAINT CONTROL NUMBER: 08-AS-20220125092004

FACILITY NAME:	IVY PARK AT OTAY RANCH		FACILITY NUMBER:	374604455
ADMINISTRATOR:	KAPLIOFF, ANGELA		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:	08/28/2023
		UNANNOUNCED	TIME BEGAN:	01:31 PM
MET WITH:	Executive Director, Calais Angiano		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Staff did not meet resident's hygiene needs
Staff did not provide incontinence care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced complaint investigation visit to follow up on the investigation of the above allegations. LPA met with the Executive Director, Calais Angiano to whom she discussed the purpose of the visit. During this visit, LPA conducted a tour of the memory care unit. In addition, LPA conducted additional interviews and reviewed resident and facility records. LPA concluded the investigation and delivered the findings.

The Department investigated the above-listed complaint allegations. The investigation consisted of observations, a review of relevant records, and interviews with facility staff and outside sources. On January 25, 2022, Community Care Licensing (CCL) received a complaint alleging that facility staff did not meet a resident’s hygiene needs (R1), [an LIC 811 Confidential Names List was provided to staff to identify the resident].

(Continue at LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2023

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-20220125092004

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: 08/28/2023

NARRATIVE

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Continue from LIC 9099)
It was specifically alleged that on January 25, 2022, R1 was observed ungroomed with dirty hair and dirty clothes at the day program. According to outside sources, this was not the first time R1 had been observed in similar conditions. However, details of any other incidents when this occurred were not provided during the investigation. A review of R1’s services care plan indicated that R1 was ambulatory and needed assistance with showers and incontinence care. A review of the facility’s resident’s shower schedule indicated that R1 received showers twice a week on Sundays and Wednesdays. However, interviews with staff indicated that R1’s shower schedule was not always consistent due to R1 refusing to take showers as scheduled. Staff would accommodate R1’s wishes by providing flexibility and offering showers the next day or the following day as necessary. Staff stated that they tried to at least provide showers once or twice a week as necessary to meet R1’s needs. Staff documented each time R1 refused showers and the next day’s shift staff would follow up with shower attempts. During a visit conducted on January 31, 2022, and again on August 28, 2023, R1 was observed to be clean, groomed, and wearing fresh clean clothing. In addition, R1’s room was observed to be clean and free from odors. Interviews with outside sources indicated no concerns with residents not being showered as scheduled to meet residents' needs. Based on observations, record reviews, and interviews with staff and outside sources there was insufficient evidence to support the allegation that staff did not meet R1’s hygiene needs.

It was also alleged that staff did not meet R1’s incontinence care needs. It was specifically alleged that R1 would arrive at the day program without wearing adult briefs and as a result, R1 would wet their pants. During interviews, facility staff indicated they would always make sure R1 wore adult briefs before leaving the facility for the day program. However, staff stated that it was typical behavior for R1 to take off their adult briefs multiple times during the day. Staff indicated that R1 did not always wear adult briefs during the day because they could at times independently use the restroom without assistance. R1’s service plan included incontinence care mostly to meet R1's needs during the night. Staff conducted incontinence care every 2 hours at night or as needed to meet R1’s needs. However, during the day, staff encouraged independence and tried to accommodate R1’s needs by providing flexibility about not wearing adult briefs as much as possible. Instead, staff provided reminders and prompting for R1 to take bathroom breaks as needed to meet their needs. Interviews with outside sources consistently indicated that staff were meeting residents’ incontinence care needs through individual toileting plans. Based on observations and multiple interviews, there was insufficient evidence that staff were not meeting R1’s incontinence care needs.
(continue at LIC9099C

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2023

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20220125092004

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: 08/28/2023

NARRATIVE

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Continue from LIC9099C)

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, to whom a copy of this report and the Licensee Appeal Rights (LIC9058 01/16) was provided at the conclusion of the visit.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2023

LIC9099 (FAS) - (06/04)

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