385600429-5-14-2024-14-AS-AMEN-D5QM4X-20240529091724

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 385600429
Report Date: 01/04/2024
Date Signed: 05/14/2024 03:54:39 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/26/2023 and conducted by Evaluator John Calandra

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20231226123813

FACILITY NAME:	IVY PARK AT CATHEDRAL HILL		FACILITY NUMBER:	385600429
ADMINISTRATOR:	ELLA FRICK		FACILITY TYPE:	740
ADDRESS:	1550 SUTTER STREET		TELEPHONE:	(415) 921-1552
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94109
CAPACITY:	210	CENSUS: 123	DATE:	01/04/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Ella Frick, Executive Director		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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8
9

-Staff did not ensure they have records for new residents
-Facility has a pest infestation
-Staff did not keep residents personal information confidential

INVESTIGATION FINDINGS:

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2
3
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5
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8
9
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13

This report was Amended due to new information being found through the course of the investigation. Report was reviewed with Fili Igafo, Executive Director and a copy of the report left at the facility.

On January 4, 2024, Licensing Program Analyst(LPA), John Calandra and Licensing Program Manager(LPM), Cara Smith arrived at the facility at 9:30 am to open a complaint with four allegations. LPA Calandra and LPM Smith met with Ella Frick, Executive Director and asked for the following documents:
-Roster with apartment numbers and move-in dates.
-Resident files
-Pest Control Inspection Reports

LPA Calandra and LPM Smith took a tour of the facility's common spaces including dining rooms and a cafe on the first, second, and fourth floors which were observed to be clean and orderly. LPA and LPM reviewed four resident records. Assessments were up to date. Newly admitted residents records were also observed to be complete. LPA and LPM collected resident documents and pest control inspection reports. LPA Calandra and LPM Smith also interviewed Arturo Balancas, Senior Maintenance Director. No concerns were noted.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are unsubstantiated.

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Andrea Medlin	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: John Calandra	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024

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 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/26/2023 and conducted by Evaluator John Calandra

COMPLAINT CONTROL NUMBER: 14-AS-20231226123813

FACILITY NAME:	IVY PARK AT CATHEDRAL HILL		FACILITY NUMBER:	385600429
ADMINISTRATOR:	ELLA FRICK		FACILITY TYPE:	740
ADDRESS:	1550 SUTTER STREET		TELEPHONE:	(415) 921-1552
CITY:	SAN FRANCISCO	STATE: CA	ZIP CODE:	94109
CAPACITY:	210	CENSUS: 123	DATE:	01/04/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Ella Frick, Executive Director		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

-Staff did not assess resident for a higher level of care

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On January 4, 2024, Licensing Program Analyst(LPA) John Calandra and Licensing Program Manager(LPM) Cara Smith conducted a complaint investigation regarding the facility not assessing a resident for higher level of care. LPA Calandra and LPM Smith reviewed the facility's roster listing apartment numbers and resident names but could not find any individuals living at the facility with the name listed in the complaint. LPA Calandra and LPM Smith reviewed four resident records which were observed to be complete with assessments.

This agency has investigated the complaint alleging that staff did not assess resident for a higher level of care. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.”

Unfounded

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Cara Smith	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: John Calandra	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 01/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024

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

LIC9099 (FAS) - (06/04)

Page: 2 of 2