385600429-11-7-2024-14-AS-AMEN-DAYN2X-20241113090526

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 385600429
Report Date: 11/07/2024
Date Signed: 11/07/2024 03:59:10 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
08/14/2024 and conducted by Evaluator Dominic Tobola

COMPLAINT CONTROL NUMBER: 14-AS-20240814165101

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:	DATE:	11/07/2024
		UNANNOUNCED	TIME BEGAN:	02:43 PM
MET WITH:	Fili Igafo, Executive Director		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Facility staff are locking residents in their bedrooms
Facility staff are not conducting planned activities with residents

INVESTIGATION FINDINGS:

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On 11/7/2024, Licensing Program Analyst (LPA) Tobola arrived unannounced for the purpose of delivering complaint investigation findings and was greeted by Administrator, Fili Igafo. LPA toured the facility, interviewed staff, gathered facility records and made observations during the course of the investigation.

Complaint alleges facility staff are locking residents in their bedrooms. Based upon tours of the facility memory care unit and observations, LPA found that all resident door handles have been modified and requires a key to open from the outside of the bedroom. Complaint further alleges that residents are not able to exit due to diagnoses of dementia. Residents however are able to freely leave the bedroom as all bedroom doorknobs do not have a locking mechanism or any devices preventing residents exiting from inside the bedroom (photos taken). LPA attempted to contact Local San Francisco Fire Inspector for additional details on fire safety requirements but was unable to conduct interview due to no response or returned contact. Due to a lack of corroborating evidence the allegation is found to be unsubstantiated.

Continued onto LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Andrea Medlin	TELEPHONE: (650) 266-8811
LICENSING EVALUATOR NAME: Dominic Tobola	TELEPHONE: (650) 393-9128
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024

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 14-AS-20240814165101

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: 11/07/2024

NARRATIVE

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Complaint alleges facility staff are not conducting planned activities with residents. Based upon tours of the facility memory care unit LPA observed residents engaging with staff and outside parties with various activities throughout the day. The activities observed included group exercise, pet therapy, music and yoga through multiple visits in accordance with facility activity calendar. Due to a lack of corroborating evidence, the allegation is found to be unsubstantiated.

A finding that the complaint allegations, facility staff are locking residents in their bedrooms
& facility staff are not conducting planned activities with residents are unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

SUPERVISOR'S NAME: Andrea Medlin	TELEPHONE: (650) 266-8811
LICENSING EVALUATOR NAME: Dominic Tobola	TELEPHONE: (650) 393-9128
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024

LIC9099 (FAS) - (06/04)

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