385600429-5-14-2024-14-AS-AMEN-D5QM4W-20240529091724

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 385600429
Report Date: 05/14/2024
Date Signed: 05/14/2024 04:00:43 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: 147	DATE:	05/14/2024
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Fili Igafo, Executive Directors		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff did not ensure they have records for new residents
Facility has a pest infestation

INVESTIGATION FINDINGS:

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On May 14, 2024, Licensing Program Analyst (LPA) John Calandra conducted a conclusionary complaint investigation at the facility and met with Fili Igafo, Executive Director. The purpose of the visit was to deliver conclusionary findings to the initial complaint investigation on January 4, 2024. LPA gathered information relevant to the above complaint allegation and conducted interviews with staff and residents. In regard to the allegation that the facility has a pest infestation, it was determined that while the facility had pests in the past, they had not had a pest infestation and have retained pest control services. Based on this information, the finding of this allegation is determined to be unsubstantiated.

Regarding the allegation that staff did not ensure they have records for new residents, the LPA reviewed records and interviewed staff. It was determined that the facility did in fact have records for new residents.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Andrea Medlin	TELEPHONE: (650) 266-8811
LICENSING EVALUATOR NAME: John Calandra	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024

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 5

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: 147	DATE:	05/14/2024
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:			TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff did not assess resident for a higher level of care
Staff did not keep residents personal information confidential

INVESTIGATION FINDINGS:

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On May 14, 2024, Licensing Program Analyst (LPA) John Calandra arrived at the facility at 1:00 PM to conduct a complaint investigation. LPA Calandra was greeted by Fili Igafo, Executive Director and explained the purpose of the visit.

In regard to the allegation above regarding resident privacy, LPA interviewed residents and staff. Based on these interviews, it was found that there was no occasion in which facility staff did not keep a resident’s personal information confidential.

Regarding the allegation that facility staff did not assess a resident for a higher level of care, LPA reviewed R1’s files and determined that there wasn’t a need to reassess R1 for a higher level of care.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Andrea Medlin	TELEPHONE: (650) 266-8811
LICENSING EVALUATOR NAME: John Calandra	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024

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 5

Control Number 14-AS-20231226123813

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: IVY PARK AT CATHEDRAL HILL	FACILITY NUMBER: 385600429
	VISIT DATE: 05/14/2024

NARRATIVE

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The Department has investigated the complaint allegation of a personal rights violation and resident reassessment. We have found that the complaint allegations are unfounded, meaning that the allegations are false, could not have happened and/or are without a reasonable basis.

This report is provided and reviewed with the Executive Director, Fili Igafo and a copy of this report must be made available for public review upon request.

SUPERVISOR'S NAME: Andrea Medlin	TELEPHONE: (650) 266-8811
LICENSING EVALUATOR NAME: John Calandra	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 14-AS-20231226123813

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: IVY PARK AT CATHEDRAL HILL	FACILITY NUMBER: 385600429
	VISIT DATE: 05/14/2024

NARRATIVE

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The Department has investigated the above complaint allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are determined to be unsubstantiated.

This report is provided and reviewed with facility representative, and a copy of this report must be made available for public review upon request.

SUPERVISOR'S NAME: Andrea Medlin	TELEPHONE: (650) 266-8811
LICENSING EVALUATOR NAME: John Calandra	TELEPHONE: 650-266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024

LIC9099 (FAS) - (06/04)

Page: 5 of 5