Ivy Park At Santa Monica

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 are mismanaging residents medication. Staff did not have resident re-evaluated before placement into memory care Staff are not providing activities for memory care residents Staff did not provide adequate transportation for resident Staff did not ensure residents room was clean Staff did not ensure resident had bedding Staff are not allowing resident to participate in activties with husband

On 8/27/2025, at 10:30 AM, Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to conduct a complaint investigation and deliver findings for the alleged allegations. LPA identified herself and met Clifton Douyon -Administrator who was informed of the purpose of the visit. On 6/23/2025 LPA conducted an interview with Clifton Douyon-Administrator and requested copies of the following documents: Resident 1-Resident 2 (R1-R2) Client File: Physician report not dated(R1) R2 dated 4/4/2025,Pre-placement dated 4/11/2025, Admission Agreement 4/16/2025,assessment needs and service plan summery dated 4/14/2025,incident reports, Case Notes, Medication Logs, and ID/Emergency information. The investigation consisted of the following: Continued Unsubstantiatedthe state’s words, verbatim · CDSS document, Aug 28, 2025 · control 11-AS-20250618125738

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 facility fire alarm is in good repair.

** This report supersedes the report dared 03/20/2025 and is being used to clarify the findings. It does not change the findings. On 04/10/2025 Licensing Program Analyst (LPA) Troy Watson conducted an unannounced subsequent complaint investigation at the facility listed above. LPA arrived at the facility and was greeted by the Executive Director Clifton Douyon. LPA explained the purpose of the visit was to investigate and deliver findings and was granted entry. CONTINUED ON LIC9099-C Substantiatedthe state’s words, verbatim · CDSS document, Apr 10, 2025 · control 11-AS-20241127150712

Allegation investigated: Staff are not meeting resident's dietary needs. Staff isolated resident.

On 03/26/25 10am Licensing Program Analyst (LPA) Villegas conducted an initial complaint visit regarding the allegation(s) above. LPA met with Executive Director (ED) Clifton Douyon as the purpose of today’s visit was explained. The investigation consisted of the following: On 03/26/25 LPA Villegas obtained copies of the staff and resident roster, menus for February 2025-March 2025, alternative menus, list of residents with modified diets/dietary restrictions, Dietary report, Serv safe training certificate for staff #1-2 (S1-S2), and list of residents placed on isolation in the last 30 days. On 03/26/25 LPA requested the following documents for resident #1 (R1); facesheet, admission agreement dated:01/31/2018, physicians report dated:04/26/2022, needs and service plan dated:01/25/25, preplacement appraisal dated: 01/31/2018, diet clarification form dated: 2/28/25, and power of attorney documents dated 06/13/2013. On 03/26/25 from 10:20am- 12:15pm LPA conducted Interviews with residentthe state’s words, verbatim · CDSS document, Mar 26, 2025 · control 11-AS-20250317151337

Allegation investigated: Staff do not ensure facility fire alarm is in good repair.

On 03/20/2025 Licensing Program Analyst (LPA) Troy Watson conducted an unannounced subsequent complaint investigation at the facility listed above. LPA arrived at the facility and was greeted by the Executive Director Clifton Douyon. LPA explained the purpose of the visit was to investigate and deliver findings and was granted entry. The investigation consisted of the following: On 12/04/2024 Licensing Program Analyst (LPA) Troy Watson reviewed / obtained Resident Roster (dated 12/2024), Staff Roster (dated 12/2024), and Emergency Disaster Plan. Interviews were conducted, with the staff with staff S1-S8 (#1-#8) and residents R1-R7 (#1-#7). The facility ground was toured, and reports were reviewed. CONTINUED ON LIC9099-C Substantiatedthe state’s words, verbatim · CDSS document, Mar 20, 2025 · control 11-AS-20241127150712

Allegation investigated: Staff did not provide adequate supervision, resulting in a resident slipping in the shower. Staff did not meet a resident's hygiene needs. Staff did not maintain the facility in a clean and sanitary condition. Facility is in disrepair. Facility has mold. Staff yelled at a resident. Facility does not provide a safe environment for a resident.

On 10/19/24, the Community Care Licensing (CCL) associate made an unannounced visit to the facility and was greeted by Sales & Marketing Director (S10: Cyr Mongo). The purpose for today’s visit is to conduct a subsequent visit to deliver the findings pertaining to the above-mentioned allegations. An initial investigation visit was conducted by (CCL) associates on 03/04/24 who was met by Administrator (S1: Matthew Ryan, Executive Director). (CCL) associates toured the facility’s physical plant for health and safety purposes of residents in care. (CCL) associates obtained copies of the following documents: Facility Resident Roster, Personnel Report LIC 500, Facility Order Review Report, Facility Rent Roll Detail Report, Facility Work Order Reports, Facility Average Daily Occupancy and Census Report, Facility Staff Training Records, Resident #1 (R1’s) care plan, email correspondences and other records pertinent to the allegations mentioned in this complaint. (Evaluation Report continues Lthe state’s words, verbatim · CDSS document, Oct 19, 2024 · control 11-AS-20240226091417

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: Facility staff did not administer medication as prescribed.

On 07/01/24, at 1:23pm, Licensing Program Analyst (LPA) Perry Scott conducted a 10-day complaint visit to the facility and was greeted by Hugo Lemus, Health Services Director, and Richard Alvarenga, Memory Care Director. LPA explained the purpose of this visit is to gather information about the complaint and deliver findings for the allegation mentioned above. The investigation consisted of the following: LPA investigated the allegation mentioned in this complaint; and conducted interviews with staff (S1-S4) and residents (R1-R6). Resident Roster (Dated: 06/13/2024) Staff Roster (Dated: No Date), ID/Emergency Information (Dated: 03/27/2024), Physicians Report (Dated: 01/31/2024 & 07/02/2024), Medication Administration Record (Dated: 06/01/24-06/30/2024) were obtained from the facility for R1. The investigation revealed the following: Allegation #1- Facility staff did not administer medication as prescribed. Report continued on LIC9099-C Unsubstantiatedthe state’s words, verbatim · CDSS document, Jul 17, 2024 · control 11-AS-20240628130119

Allegation investigated: Staff did not safeguard resident’s personal belongings

** This report serves as an amendment to clarify findings. It does not supersede the complaint investigation findings reflected on report created 06/13/2024.** On 06/13/2024 at 08:00 am the department conducted an initial complaint investigation for the allegation listed above. Upon arriving at the facility, LPA met with Henry Reyes, Business Office Director and Patricia Murphy, Executive Director who assisted with the visit. The purpose of today’s visit was discussed. LPA was granted access and allowed to enter the facility to conduct inspections. The investigation consisted of the following: On 06/13/2024 the department requested a review of current staff/resident roster, admissions agreement, house rules, pre-placement appraisal, and resident personal property and valuables. On 06/13/2024 the deparmtent interviewed Staff 1- Staff 6 (S1-S6) and Resident 1- Resident 6 (R1-R6). Continued on 9099-C Continued on LIC 9099C. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jun 13, 2024 · control 11-AS-20240603080145

Allegation investigated: Staff is overcharging resident for services. Staff did not provide resident with itemized list of fees.

*This report serves as an amendment to clarify findings. It does not supersede the complaint investigation findings reflected on report created 4/8/24. On 4/8/24 Licensing Program Analyst (LPA) Felisa Shirley, conducted an unannounced subsequent visit to the address listed above. LPA arrived and spoke to Business Office Manager, Henry Reyes and the purpose of the visit was discussed. LPA was granted access to the facility. The investigation consisted of the following: On 03/06/24 LPA Shirley conducted interviews with both staff and residents, a review of Staff roster, Resident roster, Resident files, Admission Agreements, Summary of Fees and conducted a tour of the facility for a health and safety check. The investigation revealed the following: Con'd on 9099-C Unsubstantiatedthe state’s words, verbatim · CDSS document, Apr 8, 2024 · control 11-AS-20221109093215

Allegation investigated: Staff did not manage resident's illness while in quarantine Staff did not meet resident's toileting needs while in quarantine Staff do not ensure that hallways are free from hazards Staff did not address inappropriate interaction between residents

On 01/29/24 Licensing Program Analyst (LPA) Mario Leon conducted an initial, unannounced, complaint visit at the above-mentioned facility. LPA was met by Judith Uy-Villaruz (S1), Executive Director, and the purpose of the visit was explained. S1 and LPA toured the facility. The investigation consisted of the following: On 01/29/24 LPA requested and reviewed facility documents and toured the facility. LPA interviewed seven (7) out of seventy-one (71) residents and four (4) out of seventy-two (72) staff, one staff denied the interview. Report continues, see LIC9099C Unsubstantiatedthe state’s words, verbatim · CDSS document, Jan 29, 2024 · control 11-AS-20240123102547

Allegation investigated: Licensee did not provide notice of rate change to resident. Licensee is overcharging resident for services. Licensee did not provide resident with itemized list of fees.

On 12/27/2023 at 8:45 am Licensing Program Analyst (LPA) David España conducted a subsequent complaint investigation at the above facility to address the following allegations due to needs further investigation of control number 11-AS-20231220152313. LPA España met with Executive Director Judith Uy-Villaruz and explained the purpose of this visit was to deliver findings to control number 11-AS-20231220152313 complaint. Upon arrival at the facility, LPA España conducted a risk assessment at the facility entrance. Based on the assessment, the facility is not clear of Covid-19 infection. The investigation consisted of the following: during today's visit, LPA with Executive Director Judith Uy-Villaruz confirmed positive cases at the facility as of 12/27/2023. It has been determined that there are a total Seven (7) out of Seventy (70) residents still positive with COVID-19. LPA reviewed and received from the Administrator the COVID 19 community tracker as of 12/27/2023 at 9:00 am. EVALUATIOthe state’s words, verbatim · CDSS document, Dec 27, 2023 · control 11-AS-20231220152313

Allegation investigated: Facility is not reporting a COVID-19 outbreak as required.

This is an amendment of the investigation report delivered on 12/27/2023, the purpose of this amendment is to provide additional information and it does not change the investigation findings. On 12/27/2023 at 8:45 am Licensing Program Analyst (LPA) David España conducted a subsequent complaint investigation at the above facility to address the following allegations due to needs further investigation of control number 11-AS-20231220105042. LPA España met with Executive Director Judith Uy-Villaruz and explained the purpose of this visit was to deliver findings on control number 11-AS-20231220105042 complaint. Upon arrival at the facility, LPA España conducted a risk assessment at the facility entrance. Based on the assessment, the facility is not clear of Covid-19 infection. The investigation consisted of the following: during today's visit, LPA with Executive Director Judith Uy-Villaruz confirmed positive cases at the facility as of 12/27/2023. It has been determined that there are a tothe state’s words, verbatim · CDSS document, Dec 27, 2023 · control 11-AS-20231220105042

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 left residents in soiled urine/feces resulting in a rash. Staff providing residents the same plate the dog eats from.

On 08/16/2023, Licensing Program Analyst (LPA) Antonine Richard conducted an unannnounced complaint visit at this facility, LPA was greeted by Executive Director Judith Uy-Villaruz. LPA explained the purposed of today's complaint investigations. The investigation consisted of the following: during today's visit, LPA Richard with Excecutive Director Villaruz conducted the toured of the facility, interviewed ten (10) out of sixty six (66) Residents R1-R10 and interviewed (10) out of seventy six (76) staff C1-C10. LPA also conducted records reviews of staff, facility and resident records. LPA Richard requested copies of staff rand redident rosters, medical records for resident R1 and R2. The investigation revealed the following: it is being alleged that "staff left residents in soiled urine/feces resulting in a rash." "Staff providing residents the same plate the dog eats from." During the tour of the faciltity. Unsubstantiatedthe state’s words, verbatim · CDSS document, Aug 16, 2023 · control 11-AS-20230808094356