374604455-9-25-2024-08-AS-SJAB-D9LV7M-20240930161123

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604455
Report Date: 09/25/2024
Date Signed: 09/25/2024 12:04:45 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/29/2024 and conducted by Evaluator Ramon Serrano

COMPLAINT CONTROL NUMBER: 08-AS-20240729110908

FACILITY NAME:	IVY PARK AT OTAY RANCH		FACILITY NUMBER:	374604455
ADMINISTRATOR:	CALAIS ANGUIANO		FACILITY TYPE:	740
ADDRESS:	1290 SANTA ROSE DRIVE		TELEPHONE:	(619) 779-7400
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91913
CAPACITY:	137	CENSUS: 96	DATE:	09/25/2024
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Justin Brown		TIME COMPLETED:	12:10 PM

ALLEGATION(S):

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Facility financially abused resident
Staff moved a resident who doesn’t have dementia to the memory care unit
Staff instructed residents not to use their pendants, or they will be charged extra for using them

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced complaint visit to deliver findings on the above allegations. LPA met with Maintenance Director Justin Brown and we discussed the purpose of the visit and elements of the complaint.

Community Care Licensing (CCL) has investigated the above allegations. The investigation consisted of LPA observation, records review and interviews with facility staff, residents and outside sources.

It was alleged that facility staff financially abused Resident 1 (R1) (an LIC 811 Confidential Names List was provided to the facility representative to identify the resident) It was reported that R1 was paying for three apartments without R1's knowledge. LPA reviewed the standard fee schedule dated January 2024 as well as billing invoices dated June 2024 through August 2024. The billing invoices did not show that R1 was charged for three apartments. A slight price increase occurred on the July invoice when R1 moved to the memory care unit. LPA interviewed an outside source (OS) who stated that in regards to the facility billing for R1's room.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024

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 08-AS-20240729110908

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: IVY PARK AT OTAY RANCH	FACILITY NUMBER: 374604455
	VISIT DATE: 09/25/2024

NARRATIVE

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R1 was recently upgraded to a private suite which means R1 has two rooms, that the facility bills separately. OS stated that R1 gets billed for two rooms but it's not being done fraudulently.

It was reported that R1 does not have a dementia diagnosis and was moved to the memory care unit in error. Records review of R1's Physician's report revealed R1 has a dementia diagnosis. Physician's report also indicated that R1 gets confused and disoriented. R1 wanders and requires assistance with medication management. LPA interviewed outside source (OS) who stated that R1 "absolutely" should be in the memory care unit. OS stated that R1 has a dementia diagnosis and R1's doctor recently conducted R1's yearly check-up which found R1 to have more memory loss. OS stated that R1 has memory discrepancies 50-60 seconds after something is told to R1.

It was alleged that staff instructed residents not to use their pendants, or they will be charged extra for using them. LPA interviewed Memory Care Director (MCD) who stated that although their are call buttons in the bathrooms in memory care, their are no call pendants in the bedrooms. MCD stated that they keep "eyes' on the memory care residents throughout the day by keeping them out of their rooms. MCD stated that for the few residents that remain in their rooms staff members check up on them often. LPA interviewed outside source (OS) who stated that R1 did utilize their call pendant in the assisted living (AL) side of the facility, but OS found that call pendants are not a tool used in the memory care section of the facility. LPA interviewed outside source 2 (OS2) who stated that her father has lived at the facility for 4.5 years. OS2 stated that she is very pleased with the facility and the memory care unit. OS2 stated that the memory care staff are highly attentive to her father's needs. OS2 stated that she highly recommends the facility since they have great communication between the facility and the resident's family. LPA observation found that the call pendant device is not used in the bedrooms of the memory care unit. No evidence was found to substantiate the claim that residents were instructed not to use call pendants which are non-existent in the memory care unit.

Based upon the foregoing, the above listed allegations are unsubstantiated. This finding means that the preponderance of the evidence standard has not been met and the allegations are not valid.

An exit interview was conducted with John Brown. A copy of this report along with licensee rights (LIC 9058, 3/22) was provided to John Brown whose signature below verifies receipt of these rights.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024

LIC9099 (FAS) - (06/04)

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