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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 275202849
Report Date: 10/21/2024
Date Signed: 10/28/2024 10:53:32 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO ASC, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/17/2024 and conducted by Evaluator Sarah Hurt
COMPLAINT CONTROL NUMBER: 24-AS-20241017124757
FACILITY NAME:IVY PARK AT SALINASFACILITY NUMBER:
275202849
ADMINISTRATOR:POST, SARAFACILITY TYPE:
740
ADDRESS:1320 PADRE DRIVETELEPHONE:
(831) 754-5532
CITY:SALINASSTATE: CAZIP CODE:
93901
CAPACITY:185CENSUS: 156DATE:
10/21/2024
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Business Office Manager, Andrea RamirezTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident was billed for services not rendered.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Sarah Hurt arrived at the facility unannounced on October 21, 2024 at 01:00 p.m. to investigate the above allegations. LPA met with facility Business Office Manager, Andrea Ramirez and explained the purpose for today’s visit.
Regarding the allegation resident was billed for services not rendered. Resident 1's assesment stated they need assistance with 6 to 10 medications. Resident 1's "medication clarification list" signed by Physician on 09/03/2924 lists 6 as needed medications in addition to the 5 routine medications. Resident 1 is being billed for assistance with 6 to11 medications including PRN's. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

No deficincies cited today Per Title 22 Regulations.

Exit interview conducted with facility Assistant Executive Director, Andrea Ramirez , and copy of report provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2024
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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