Ivy Park At West Hills

Allegation investigated: Staff’s medication administration error led to a resident’s hospitalization.

Licensing Program Analyst (LPA) Tihesha Smith conducted an unannounced initial complaint visit. LPA Smith met with the regional operations specialist and executive director trainees and disclosed the reason for the visit. Staff’s medication administration error led to a resident’s hospitalization It was alleged that Resident #1 (R1) experienced symptoms of an overdose requiring hospitalization due to R1 being administered the wrong medication and/or dosage. To investigate the allegation LPA Smith interviewed three (3) staff from 11:00am - at 12:20 pm, requested documents relevant to the investigation during interviews and reviewed facility records at 12:35 pm. Interviews with three (3) of three (3) staff reveal the following: R1 was sent to Kaiser on 04/12/26 due to receiving improper medication, was observed to be drowsy and not at baseline. Review of Kaiser discharge records reveal Substantiatedthe state’s words, verbatim · CDSS document, Apr 29, 2026 · control 31-AS-20260420122935

Allegation investigated: Staff’s medication administration error led to a resident’s hospitalization.

Licensing Program Analyst (LPA) Tihesha Smith conducted an unannounced initial complaint visit. LPA Smith met with the regional operations specialist and executive director trainees and disclosed the reason for the visit. Staff’s medication administration error led to a resident’s hospitalization It was alleged that Resident #1 (R1) experienced symptoms of an overdose requiring hospitalization due to R1 being administered the wrong medication and/or dosage. To investigate the allegation LPA Smith interviewed three (3) staff from 11:00am - at 12:20 pm, requested documents relevant to the investigation during interviews and reviewed facility records at 12:35 pm. Interviews with three (3) of three (3) staff reveal the following: R1 was sent to Kaiser on 04/12/26 due to receiving improper medication, was observed to be drowsy and not at baseline. Review of Kaiser discharge records reveal Substantiatedthe state’s words, verbatim · CDSS document, Apr 29, 2026 · control 31-AS-20260420122935

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Allegation investigated: Staff locked residents in their rooms. Staff did not change residents in care.

At 9:00am Licensing Program Analysts (LPAs) Perchui Milena Khurshudyan and Angela Panushkina conducted a subsequent visit to deliver final findings. Upon arrival, LPAs met with the Executive Director (ED) Lidia Cauchi and explained the reason for the visit. During the initial visit conducted on 04/18/2025, at 09:05am, LPAs requested residents and staff rosters. LPAs also requested copies of pertinent information which include, but not limited to Mandated Reporting policy, Staff training log, Incontinent Plan of Operation, Staff work schedule for one week, Staff work daily log for one month. At approximately 09:25am, LPAs conducted a physical plant tour, to ensure health and safety of the residents are protected. Between 9:30am – 11:10am, LPAs conducted interviews with the Executive Director, Memory Care Director, three (3) out of six (6) staff/caregivers, nine (9) out of ten (10) residents who were able to communicate and one (1) witness. Also, while interviewing a sample of ten (10) rthe state’s words, verbatim · CDSS document, Dec 11, 2025 · control 31-AS-20250411152240

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Allegation investigated: Staff do not ensure that hazardous items are inaccessible to residents in care.

On 5/1/2025 at approximately 1:00pm, Licensing Program Analyst (LPA) Perchui Milena Khurshudyan made an unannounced subsequent visit to this facility to deliver final findings. LPA met with the Executive Director Lidia Cauchi and explained the reason for the visit. Initial visit was conducted by LPAs Perchui Milena Khurshudyan and Angela Panushkina on 4/9/2025, and during the initial course of investigation, LPAs requested client and staff rosters. At 10:25am, LPAs requested pertinent documentation which include, but not limited to Admission Agreement, Appraisal Needs and Services, Physician Report, Unusual Incident Reports, copy of R1's Assesment report, copy of facility Plan of Operation, copy of staff training, copy of staff shift schedules, copy of staff files, copy of facility internal investigation summary, copy of staff suspension summary, etc. relevant to the investigation. At approximately 10:45am, LPAs conducted a physical plant tour, to ensure health and safety of the residethe state’s words, verbatim · CDSS document, May 1, 2025 · control 31-AS-20250407131128

Allegation investigated: Staff does not allow residents to possess personal belongings. Staff does not ensure that residents' incontinence needs are met. Staff confines residents to bedrooms. Staff does not answer residents' call buttons in a timely manner. Staff does not ensure that resident is afforded a comfortable accommodation. Staff speaks inappropriately to residents.

At 09:30am, Licensing Program Analysts (LPAs) Perchui Milena Khurshudyan and Angela Panushkina conducted an initial visit to investigate the above allegations. LPAs met with the Memory Care Director (MCD) and explained the reason for the visit. During course of the investigation, interviews and record review were made. At 9:35am, LPAs requested resident and staff roster. At 09:40am, LPAs requested copies of pertinent information which include, but not limited to Policy and Procedures for an Emergency Response System, Emergency Call Log, etc., relevant to the investigation. At approximately 9:50am, LPA conducted a physical plant tour, to ensure health and safety of the residents are protected. Between 10:00am – 1:00pm, LPAs conducted interviews with the Memory Care Director (MCD), four (4) staff members, one (1) MedTech, six (6) residents and one (1) witness. Also, while interviewing a sample of six (6) residents, LPAs randomly tested resident’s emergency pull cords in rooms and bathroothe state’s words, verbatim · CDSS document, Dec 26, 2024 · control 31-AS-20241220102450

Allegation investigated: Staff did not utilize universal precautions to care for residents affected with scabies.

This is an Amendment to the original report issued on 12/26/2024. Additional information was added to clarify the investigation. On 11/25/2024, during the initial ten-day complaint visit conducted by LPA Khurshudyan, LPA obtained copies of the staff and resident rosters and requested ten (10) resident files. At 11:45am, LPA conducted a physical plant tour including the Memory Care Unit to ensure health and safety of the residents are protected. In addition, between 12:30pm and 3:30pm LPA reviewed files and interviewed eight (8) out of seventy-one (71) residents who were able to communicate; four (4) from the Assisted Living, four (4) from Memory Care Unit, and total of five (5) staff members including Executive Director, and four (4) caregivers/Med-Techs. Interviews with the Executive Director (ED) and staff revealed that residents at Memory Care unit had some type of rash and itching on their skin for the past few months. Continue on LIC9099-C Substantiatedthe state’s words, verbatim · CDSS document, Dec 26, 2024 · control 31-AS-20241119092225

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.

Report on file with the state — no findings text was published for this visit. The complete document is on the state’s site.