Inspection Reports for Ivy Park at Santa Monica
1312 15th Street Santa Monica, CA 90404, CA, 90404
Back to Facility ProfileInspection Report Summary
Most inspections found no deficiencies, and several complaint investigations were unsubstantiated, indicating generally good compliance with regulations. The most recent report from September 17, 2025, was an annual inspection with no deficiencies observed. Earlier in 2025, two complaint investigations substantiated issues with malfunctioning fire alarms that posed a potential safety risk, resulting in citations, but these concerns were not present in the latest inspection. Other substantiated findings include a late COVID-19 outbreak report in late 2023 and an isolated issue in 2021 where a memory care resident was not adequately protected from ingesting harmful objects. Overall, the facility appears to have addressed past deficiencies, with recent reports showing improvement and no new serious issues.
Deficiencies per Year
4
3
2
1
0
High
Moderate
Census Over Time
Census
Capacity
Inspection Report
Annual Inspection
Census: 70
Capacity: 100
Deficiencies: 0
Sep 17, 2025
Visit Reason
An unannounced annual required inspection visit was conducted to evaluate compliance with licensing requirements.
Findings
The facility was found to be in compliance with all applicable regulations with no deficiencies observed. The physical plant, staff files, resident files, medication administration, safety equipment, and food supplies were all inspected and found to be satisfactory.
Report Facts
Rooms inspected: 6
Bathrooms inspected: 6
Staff files reviewed: 7
Resident files reviewed: 7
Residents' Medication Administration Records audited: 4
Fire drill date: Sep 15, 2025
Perishable food supply days: 5
Non-perishable food supply days: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Bernadette Allen | Licensing Program Analyst | Conducted the inspection and audit |
| Clifton Douyon | Administrator | Facility administrator met during inspection and exit interview |
| Stephanie Cifuentes | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 71
Capacity: 100
Deficiencies: 0
Aug 28, 2025
Visit Reason
An unannounced complaint investigation was conducted following a complaint received on 2025-06-18 regarding multiple allegations about resident care and facility operations at Ivy Park at Santa Monica.
Findings
The investigation included interviews with staff and residents, document reviews, and observations. All allegations including medication mismanagement, lack of resident re-evaluation before memory care placement, inadequate activities, transportation issues, room cleanliness, bedding provision, and restrictions on resident participation in activities were found to be unsubstantiated due to insufficient evidence.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included staff mismanaging medication, failure to re-evaluate residents before memory care placement, lack of activities, inadequate transportation, unclean rooms, lack of bedding, and restricting resident participation in activities with their husband. Interviews and document reviews did not support these allegations.
Report Facts
Facility capacity: 100
Census: 71
Complaint control number: 11-AS-20250618125738
Number of staff interviewed: 5
Number of residents interviewed: 3
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Bernadette Allen | Licensing Program Analyst | Conducted the complaint investigation and interviews |
| Stephanie Cifuentes | Licensing Program Manager | Oversaw the complaint investigation |
| Clifton Douyon | Administrator | Facility administrator met during investigation and exit interview |
| Judith Uy Villaruz | Administrator | Named as facility administrator in report header |
Inspection Report
Census: 71
Capacity: 100
Deficiencies: 0
Aug 27, 2025
Visit Reason
An unannounced case management health and safety visit was conducted due to a resident-on-resident physical altercation.
Findings
The Administrator reported that the involved residents were separated into different rooms, responsible parties were notified, and staff will continue to monitor behaviors. No health or safety concerns were observed during the visit.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Clifton Douyon | Administrator | Met with during the visit and provided information about the incident and corrective actions. |
| Bernadette Allen | Licensing Program Analyst | Conducted the unannounced case management health and safety visit. |
| Stephanie Cifuentes | Licensing Program Manager | Named as Licensing Program Manager on the report. |
Inspection Report
Complaint Investigation
Census: 66
Capacity: 100
Deficiencies: 1
Apr 10, 2025
Visit Reason
The inspection was an unannounced complaint investigation conducted in response to a complaint received on 2024-11-27 alleging that staff did not ensure the facility fire alarm was in good repair.
Findings
The investigation found that smoke detectors in rooms 118 and 221 were dysfunctional and intermittently sounding off due to construction and rainwater damage. Interviews with staff and residents confirmed the allegation. The smoke detectors were disconnected and not functioning, and no confirmed repair order or estimated repair time was obtained. The allegation was substantiated and a citation was issued.
Complaint Details
The complaint was substantiated. The allegation was that staff did not ensure the facility fire alarm was in good repair. Interviews with 8 staff and 7 residents all agreed with the allegation. The Executive Director and Maintenance Director confirmed the smoke detectors were disconnected and not functioning. No confirmed repair order or estimated repair time was obtained.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair at all times. The fire alarm system was in disrepair and malfunctioning since 2024-11-27, posing a potential health and safety risk. | Type A |
Report Facts
Capacity: 100
Census: 66
Staff interviewed: 8
Residents interviewed: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Clifton Douyon | Executive Director | Interviewed regarding the fire alarm issue and participated in exit interview |
| Glen Olano | Maintenance Director | Interviewed and toured facility grounds confirming smoke detectors were disconnected |
| Troy Watson | Licensing Program Analyst | Conducted the complaint investigation |
| Stephanie Cifuentes | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Complaint Investigation
Census: 67
Capacity: 100
Deficiencies: 0
Mar 26, 2025
Visit Reason
The visit was an unannounced complaint investigation conducted in response to allegations that staff were not meeting residents' dietary needs and that staff isolated a resident without proper notification.
Findings
The investigation found that 5 of 6 residents and all staff denied the dietary needs allegation, with only 1 resident confirming the issue regarding ungrounded food. Regarding isolation, 5 of 6 residents and all staff denied improper isolation, with documentation supporting isolation orders and notification. The allegations were ultimately unsubstantiated due to insufficient evidence.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included staff not meeting dietary needs and isolating a resident without informing them. Interviews, document reviews, and observations were conducted. Evidence did not support the allegations sufficiently to confirm violations.
Report Facts
Residents interviewed: 6
Staff interviewed: 6
Isolation duration: 21
Facility capacity: 100
Census: 67
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Lizeth Villegas | Licensing Program Analyst | Conducted the complaint investigation and interviews |
| Clifton Douyon | Executive Director | Met with Licensing Program Analyst during investigation |
| Judith Uy Villaruz | Administrator | Facility administrator named in report header |
Inspection Report
Complaint Investigation
Census: 68
Capacity: 100
Deficiencies: 1
Mar 20, 2025
Visit Reason
An unannounced complaint investigation was conducted in response to an allegation that staff did not ensure the facility fire alarm was in good repair.
Findings
The investigation substantiated that the fire alarms in rooms 118 and 221 were dysfunctional and intermittently sounded due to construction and rainwater issues. The facility was found to have a potential health and safety risk due to malfunctioning fire alarms, and a citation was issued.
Complaint Details
The complaint alleged that the fire alarm was broken and randomly went off unexpectedly, disturbing residents. Interviews with 8 staff and 8 residents confirmed the allegation. The Executive Director and Maintenance Director confirmed the smoke detectors were dysfunctional and needed repair. Attempts to verify repair parts and timing were unsuccessful. The allegation was substantiated.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees, and visitors. | Type A |
Report Facts
Capacity: 100
Census: 68
Deficiency Type: 1
Plan of Correction Due Date: Mar 27, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Clifton Douyon | Executive Director | Interviewed regarding fire alarm issues and participated in exit interview |
| Glen Olano | Maintenance Director | Interviewed and toured facility grounds confirming smoke alarm issues |
| Troy Watson | Licensing Program Analyst | Conducted the complaint investigation |
| Stephanie Cifuentes | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Capacity: 100
Deficiencies: 0
Oct 19, 2024
Visit Reason
The visit was an unannounced complaint investigation conducted to address multiple allegations including inadequate supervision resulting in a resident fall, unmet hygiene needs, unsanitary conditions, facility disrepair, mold presence, staff verbal mistreatment, and unsafe environment concerns.
Findings
After interviews, facility inspections, and record reviews, the investigation found no evidence to support the allegations. The resident was found to be largely independent, the facility was maintained in a clean and safe condition, and staff interactions were professional. The allegations were determined to be unsubstantiated.
Complaint Details
The complaint included allegations of inadequate supervision leading to a resident slipping in the shower, failure to meet hygiene needs, unsanitary and disrepair conditions including mold, staff yelling at a resident, and an unsafe environment. The investigation involved interviews with staff and residents, review of facility records, and physical inspection. The resident involved was independent and had a private care provider present during the fall. No evidence was found to substantiate the allegations, and the complaint was deemed unsubstantiated.
Report Facts
Facility capacity: 100
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Cyr Mongo | Sales & Marketing Director | Met during the investigation and exit interview |
| Judith Uy Villaruz | Administrator | Facility administrator named in report header |
| Matthew Ryan | Executive Director | Met during initial investigation visit |
| Ernand Dabuet | Evaluator / Licensing Program Analyst | Conducted the complaint investigation |
| Janae Hammond | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
Inspection Report
Annual Inspection
Census: 100
Capacity: 100
Deficiencies: 0
Sep 14, 2024
Visit Reason
An unannounced annual required visit was conducted using the CARE Inspection Tool to evaluate compliance with licensing regulations for the facility.
Findings
The facility was found to be clean, sanitary, and appropriately furnished with no observed deficiencies. All safety equipment was operable, infection control practices were followed, and no discrepancies were found in medication administration records. No citations were issued.
Report Facts
Residents' service files reviewed: 5
Staff personnel files reviewed: 5
Medication Administration Records reviewed: 5
Fire/Disaster Drills last conducted: Jun 6, 2024
Water temperature range (°F): 113.5-115.2
Room temperature range (°F): 76-78
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Clifton Douyon | Executive Director | Met with Licensing Program Analyst during inspection and received report |
| Alfonso Iniguez | Licensing Program Analyst | Conducted the inspection |
| Eva M Alvarez | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 72
Capacity: 100
Deficiencies: 0
Jul 17, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation that facility staff did not administer medication as prescribed.
Findings
The investigation included interviews with staff and residents and review of medication records. The allegation was found to be unsubstantiated due to insufficient evidence, with staff and residents denying the claim and records showing the resident self-administered insulin with staff witnessing.
Complaint Details
The complaint alleged that a resident was admitted to the hospital after the facility failed to provide insulin medication for at least 5 days. The investigation found no evidence to support this allegation, and it was determined unsubstantiated.
Report Facts
Capacity: 100
Census: 72
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Perry Scott | Licensing Program Analyst | Conducted the complaint investigation |
| Richard Alvarenga | Memory Care Director | Met with during the investigation and participated in exit interview |
| Hugo Lemus | Health Services Director | Greeted the Licensing Program Analyst during the visit |
Inspection Report
Complaint Investigation
Census: 74
Capacity: 100
Deficiencies: 0
Jun 13, 2024
Visit Reason
The visit was an unannounced complaint investigation conducted due to an allegation that staff did not safeguard residents' personal belongings.
Findings
The investigation included interviews with staff and residents, review of records, and room inspections. All interviewed staff and residents denied the allegation, and observations showed residents' belongings were secured. The allegation was found to be unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint alleged that staff did not safeguard residents' personal belongings. The allegation was unsubstantiated after investigation, including interviews with six staff members and six residents, and room inspections.
Report Facts
Capacity: 100
Census: 74
Staff interviewed: 6
Residents interviewed: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Patricia Murphy | Executive Director | Interviewed and denied the allegation |
| Henry Reyes | Business Office Director | Assisted with the visit |
| Benita Yates | Licensing Program Manager | Named in report signature and management |
| Stephanie Cifuentes | Licensing Program Analyst | Named in report signature and investigation |
| David Espana | Evaluator | Conducted the complaint investigation |
Inspection Report
Complaint Investigation
Census: 74
Capacity: 100
Deficiencies: 0
Apr 8, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations that staff were overcharging residents for services and not providing itemized lists of fees.
Findings
The investigation found no preponderance of evidence to substantiate the allegations. Interviews with staff and residents, review of resident files, admission agreements, and billing showed that while some residents were not available or records were missing due to ownership changes, there was no clear proof of overcharging or failure to provide itemized fee lists. The allegations were determined to be unsubstantiated.
Complaint Details
The complaint involved two allegations: 1) staff overcharging residents for services, and 2) staff not providing residents with an itemized list of fees. Both allegations were investigated through interviews, document reviews, and facility tours. The findings were unsubstantiated due to lack of sufficient evidence.
Report Facts
Capacity: 100
Census: 74
Staff interviewed: 6
Residents interviewed: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Henry Reyes | Business Office Manager | Met during inspection and involved in exit interview |
| Felisa Shirley | Licensing Program Analyst | Conducted the complaint investigation |
| Stephanie Cifuentes | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
Inspection Report
Complaint Investigation
Census: 71
Capacity: 100
Deficiencies: 0
Jan 29, 2024
Visit Reason
An unannounced complaint investigation visit was conducted in response to multiple allegations regarding staff management of resident illness during quarantine, toileting needs, hallway hazards, and inappropriate interactions between residents.
Findings
The investigation found no preponderance of evidence to substantiate any of the allegations. Interviews with residents and staff, as well as record reviews, indicated that the alleged violations did not occur or were unsubstantiated.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included staff not managing resident illness during quarantine, not meeting toileting needs, failing to keep hallways free from hazards, and not addressing inappropriate resident interactions. Interviews and record reviews did not support these claims.
Report Facts
Residents interviewed: 7
Staff interviewed: 4
Staff census: 72
Estimated days of completion: 90
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Judith Uy-Villaruz | Executive Director | Met with Licensing Program Analyst during the investigation and participated in exit interview |
| Mario Leon | Licensing Program Analyst | Conducted the complaint investigation visit |
| Ulysses Coronel | Licensing Program Manager | Oversaw the complaint investigation report |
Inspection Report
Complaint Investigation
Census: 70
Capacity: 100
Deficiencies: 1
Dec 27, 2023
Visit Reason
The inspection was an unannounced complaint investigation triggered by an allegation that the facility was not reporting a COVID-19 outbreak as required.
Findings
The investigation found that the facility failed to report a COVID-19 outbreak to the licensing agency within 24 hours as required, despite having seven active COVID-19 positive residents at the time of the visit. This failure posed a potential health, safety, or personal rights risk to persons in care. The allegation was substantiated.
Complaint Details
The complaint alleged that the facility was not reporting a COVID-19 outbreak as required. The allegation was substantiated based on observations, interviews, and record reviews. The facility had seven active COVID-19 positive residents and did not report the outbreak timely to the licensing agency.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to report COVID-19 outbreak within 24 hours as required by regulation. | Type B |
Report Facts
Residents positive for COVID-19: 7
Total residents: 70
Total licensed capacity: 100
Staff working: 22
Positive cases between 11/18/2023 and 12/22/2023: 19
Plan of Correction due date: Jan 5, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Judith Uy-Villaruz | Administrator | Met with Licensing Program Analyst during investigation and named in findings |
| David Espana | Licensing Program Analyst | Conducted the complaint investigation |
| Ulysses Coronel | Licensing Program Manager | Named in report headers and signatures |
Inspection Report
Complaint Investigation
Census: 70
Capacity: 100
Deficiencies: 0
Dec 27, 2023
Visit Reason
The visit was an unannounced complaint investigation conducted to address allegations including failure to provide notice of rate change to residents, overcharging residents for services, and failure to provide an itemized list of fees.
Findings
The investigation found that although allegations were made regarding rate change notices, overcharging, and itemized fee lists, there was insufficient evidence to substantiate any violations. The facility had seven residents positive for COVID-19 at the time of visit, and all allegations were determined unsubstantiated with no deficiencies cited.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included failure to provide notice of rate change, overcharging residents, and not providing itemized fee lists. Interviews with residents, staff, and the administrator, along with document reviews, showed that notices were sent, residents were aware of rate increases due to operational costs, and itemized fees were included in resident agreements. No evidence supported the allegations.
Report Facts
Residents positive for COVID-19: 7
Facility census: 70
Facility capacity: 100
Staff interviewed: 7
Residents interviewed: 7
Staff working at time of visit: 22
Rate increase percentage: 10
Letters sent about rate change: 48
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| David Espana | Licensing Program Analyst | Conducted the complaint investigation and authored the report. |
| Judith Uy-Villaruz | Administrator | Facility administrator interviewed during the investigation and recipient of the report. |
| Ulysses Coronel | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation. |
Inspection Report
Annual Inspection
Census: 67
Capacity: 100
Deficiencies: 0
Oct 3, 2023
Visit Reason
An unannounced Required – 1 Year Inspection was conducted to evaluate compliance with licensing regulations and facility standards.
Findings
The facility was found to be in compliance with no deficiencies cited. Resident rooms, bathrooms, common areas, and kitchen were inspected and found to meet regulatory requirements. Staff and resident records were reviewed and found complete and current.
Report Facts
Staff records reviewed: 5
Resident records reviewed: 5
Licensed capacity: 100
Hospice waiver capacity: 10
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Judith Uy Villaruz | Executive Director | Met with Licensing Program Manager and Analyst during inspection |
| Ulysses Coronel | Licensing Program Manager | Conducted the inspection |
| Socorro Leandro | Licensing Program Analyst | Conducted the inspection |
Inspection Report
Complaint Investigation
Census: 66
Capacity: 100
Deficiencies: 0
Aug 16, 2023
Visit Reason
An unannounced complaint investigation was conducted in response to allegations that staff left residents in soiled urine/feces resulting in a rash and that staff provided residents the same plate the dog eats from.
Findings
The investigation included interviews with residents and staff, a tour of the facility, and record reviews. No evidence was found to support the allegations, and the complaint was determined to be unsubstantiated. No deficiencies were cited during the visit.
Complaint Details
The complaint was unsubstantiated based on interviews with ten residents and ten staff members, observations during the facility tour, and record reviews. No evidence supported the allegations of residents being left in soiled urine/feces or sharing plates with a dog.
Report Facts
Residents interviewed: 10
Staff interviewed: 10
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Judith Uy Villaruz | Executive Director | Met with Licensing Program Analyst during complaint investigation and exit interview |
| Antonine Richard | Licensing Program Analyst | Conducted the complaint investigation |
| Ulysses Coronel | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 60
Capacity: 100
Deficiencies: 0
Jul 5, 2023
Visit Reason
An unannounced complaint investigation was conducted due to an allegation that, due to lack of adequate supervision, a resident was pushed by another resident leading to a head injury.
Findings
The investigation found no evidence to support the allegation. Interviews with residents and staff, as well as record reviews, did not substantiate the claim. No deficiencies were cited during the visit.
Complaint Details
The complaint alleged that a resident was pushed by another resident resulting in a head injury due to lack of supervision. The allegation was unsubstantiated after investigation.
Report Facts
Residents interviewed: 6
Staff interviewed: 6
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Judith Uy-Villaruz | Executive Director | Met with Licensing Program Analyst during investigation and exit interview |
| Antonine Richard | Licensing Program Analyst | Conducted the complaint investigation |
| Ulysses Coronel | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 60
Capacity: 100
Deficiencies: 1
Dec 29, 2022
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to allegations including the facility charging a resident for services not performed, failure to reassess a resident, resident injury while in care, staff harassment, and failure to provide three meals a day.
Findings
The investigation substantiated the allegation that the facility charged a resident for services not approved by the power of attorney. Other allegations including failure to reassess the resident, resident injury, staff harassment, and failure to provide three meals a day were found to be unsubstantiated based on observations, interviews, and record reviews.
Complaint Details
The complaint investigation was triggered by allegations that the facility charged a resident for services not performed, failed to reassess the resident, the resident was injured while in care, staff harassed the resident, and the facility did not provide three meals a day. The allegation regarding unauthorized charges was substantiated, while the others were unsubstantiated.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| 87507(3)(B)(2) Admissions Agreements: A separate charge for an item or service may be assessed only if that charge is included in and authorized by the admissions agreement. This requirement is not met as evidenced by facility charging resident for services not approved by POA. | Type B |
Report Facts
Facility capacity: 100
Census: 60
Deficiency count: 1
Plan of Correction due date: Jan 12, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Henry Reyes | Business Office Manager | Met during exit interview and named in relation to billing and findings |
| Kaylee Garcia | Business Office Coordinator | Spoke with Licensing Program Analyst prior to inspection and during investigation |
| Mario Leon | Licensing Program Analyst | Conducted the complaint investigation visit |
| Stephanie Cifuentes | Licensing Program Analyst | Conducted interviews and document reviews during investigation |
Inspection Report
Complaint Investigation
Census: 62
Capacity: 100
Deficiencies: 0
Aug 18, 2022
Visit Reason
The visit was an unannounced complaint investigation triggered by allegations that facility staff sexually assaulted a resident and were not following the resident's care plan.
Findings
The investigation found insufficient evidence to substantiate the allegations of sexual assault and failure to follow the care plan. Interviews with staff and residents, review of care plans, and incident reports did not support the claims. No deficiencies were cited during the visit.
Complaint Details
The complaint alleged that a facility caregiver inspected Resident #1's genital area without consent, constituting sexual assault, and that staff were not following the resident's care plan. The investigation included interviews with staff, residents, and review of medical and care documents. The complaint was ultimately unsubstantiated due to lack of evidence.
Report Facts
Capacity: 100
Census: 62
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jey Cardenas | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Milton Pineda | Maintenance Coordinator | Met with Licensing Program Analyst during the visit |
| Alberto Golia | Administrator | Facility administrator named in the report |
Inspection Report
Complaint Investigation
Census: 71
Capacity: 100
Deficiencies: 0
Mar 9, 2022
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations that the facility failed to reassess a resident, failed to notify the resident's Power of Attorney (POA) of a change in condition, and increased the rate without proper notice.
Findings
Based on interviews with staff and residents, review of documentation, and available evidence, there was insufficient evidence to substantiate the allegations. The facility provided documentation and communication records supporting their compliance, and no deficiencies were cited.
Complaint Details
The complaint was unsubstantiated. Allegations included failure to reassess resident, failure to notify POA of resident's change of condition, and improper rate increase notification. Staff and residents denied the allegations and provided supporting documentation. The investigation found no sufficient evidence to prove violations.
Report Facts
Capacity: 100
Census: 71
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Pamela Bunker | Licensing Program Analyst | Conducted the complaint investigation visit |
| Angela J Kendrick | Licensing Program Manager | Oversaw the complaint investigation report |
| Matan Burstyn | Executive Director | Met with Licensing Program Analyst during investigation |
| Aurora Israelson | Business Office Coordinator | Met with Licensing Program Analyst during investigation |
Inspection Report
Complaint Investigation
Census: 64
Capacity: 100
Deficiencies: 1
Nov 18, 2021
Visit Reason
The inspection was an unannounced complaint investigation conducted in response to allegations received on 2021-11-08 regarding illegal eviction and failure to ensure memory care resident did not have access to ingestible objects.
Findings
The investigation found the allegation of illegal eviction to be unsubstantiated due to insufficient evidence. However, the allegation that the facility nurse did not ensure a memory care resident did not have access to ingestible objects was substantiated based on interviews and records reviewed.
Complaint Details
The complaint investigation was triggered by allegations of illegal eviction and failure to protect a memory care resident from ingesting harmful objects. The illegal eviction allegation was unsubstantiated, while the ingestion allegation was substantiated.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Facility nurse did not ensure memory care resident did not have access to ingestible objects, evidenced by ingestion of soap, rubber gloves, and Halloween decorations on multiple dates. | Type B |
Report Facts
Capacity: 100
Census: 64
Deficiency Type B: 1
Plan of Correction Due Date: Dec 6, 2021
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Stephanie Cifuentes | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Matan Burnstyn | Executive Director | Interviewed during investigation and recipient of exit interview |
Inspection Report
Annual Inspection
Census: 67
Capacity: 100
Deficiencies: 0
Oct 13, 2021
Visit Reason
The inspection was an unannounced annual required visit with a primary focus on Infection Control measures using the new CARE Inspection Tool.
Findings
The facility was found to be in compliance with infection control practices, including screening protocols, PPE availability, and proper facility maintenance. No deficiencies were cited during this inspection visit.
Report Facts
Hospice waiver: 10
Non-ambulatory residents allowed: 80
Bedridden residents allowed: 20
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Stephanie Cifuentes | Licensing Program Analyst | Conducted the inspection and authored the report |
| Myra Aragones | Executive Director | Facility representative met during inspection and received report |
| Milton Pineda | Maintenance Coordinator | Assisted in touring the physical plant during inspection |
Inspection Report
Complaint Investigation
Census: 67
Capacity: 100
Deficiencies: 0
Sep 29, 2021
Visit Reason
An unannounced complaint investigation visit was conducted in response to an allegation that the facility was not accommodating residents' food preferences that meet their nutritional needs.
Findings
The investigation included interviews, file reviews, and facility inspection and found no evidence to support the allegation. The facility was found to accommodate residents' dietary needs, and the complaint was determined to be unsubstantiated.
Complaint Details
The complaint alleged that facility staff were changing a resident's special food preferences and not meeting nutritional needs. The investigation found no preponderance of evidence to prove the alleged violations, resulting in an unsubstantiated finding.
Report Facts
Capacity: 100
Census: 67
Complaint Control Number: 11-AS-20210916151040
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Stephanie Cifuentes | Licensing Program Analyst | Conducted the complaint investigation and interviews |
| Myra Aragones | Senior Executive Director | Facility representative interviewed during investigation |
| Eva M Alvarez | Licensing Program Manager | Named in report as Licensing Program Manager |
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