Ivy Park At Cerritos

Licensing Program Analyst (LPA) Wong conducted a “Subsequent” visit to ascertain additional information regarding the above-mentioned allegation(s) and for the purpose of rendering the findings. LPA met with Staff #1 Randyl Lowe (Receptionist) who allowed entry into the facility and was later met by Administrator Laura Rodriguez who assisted with the visit. The investigation consisted of the following: On 12/20/22, LPA Wong interviewed the administrator, 4 staff (S1-S4) and 13 residents (R2-R14) and obtained the current staff roster and resident roster. On 6/28/2022, Licensing Program Manager (LPM) Sicairos conducted an initial 10-day complaint and obtained copies of Staff & Resident Rosters, reviewed Former Resident #1 (FR1) file, and obtained copies of Identification and Emergency Information Sheet, Physician's Report, Admission Agreement, Service Plan, Progress Notes, Resident Appraisal, Admission Orders, and Resident Detail Ledger. LPA interviewed Ms. Mosalla and Staff #1 (S1). (SeRead the full finding— CDSS inspection report, February 1, 2024 · control 28-AS-20220623080038

Licensing Program Analyst (LPA) Alberto Lopez made an unannounced subsequent complaint investigation regarding the above allegation. LPA met with Laura Rodriguez Executive Director and explained the reason for the visit. During the visit, LPA Lopez conducted a tour of the facility with Executive Director Laura Rodriguez. LPA Lopez interviewed Executive Director S1, 4 staff S2 through S5 and total of thirteen (13) residents who shall be referred to as R1 through R13. LPA Lopez obtained staff roster, resident roster, one (1) month of work orders, Report from specialty A/C and heat dated 12/01/2023 R1’s physician report, referral for R1 to Physician dated 12/23/2023. LPA took photos of the thermostats in the facility common areas and random rooms. (Continued on 9099C) UnsubstantiatedRead the full finding— CDSS inspection report, January 18, 2024 · control 28-AS-20231219092627

On 12/04/2023 at 08:00 a.m., Licensing Program Analyst(s) (LPA) Jewel Baptiste and Sanjay Vaid conducted an unannounced subsequent complaint investigation regarding the above allegation(s). LPAs met with Laura Rodriguez Executive Director and explained the reason for the visit. During the visit on 11/30/2023, LPA Baptiste conducted a tour of the facility. LPA checked the thermostat in rooms #117,163,179,201, 210, 219, and 227 with Executive Director Laura Rodriguez. LPA Baptiste interviewed Executive Director and a total of five (5) residents who shall be referred to as R1 through R5. LPA Baptiste obtained staff roster, resident roster, one (1) month of work orders, Ontario Refrigeration dated 6/9/2023, Report from specialty A/C and heat dated 11/28/2023, R1’s physician report, and photos from Executive Director regarding the thermostat in room#117. LPA took photos of the thermostats in the facility common areas. Report Continued on 9099c UnsubstantiatedRead the full finding— CDSS inspection report, December 4, 2023 · control 28-AS-20231121100332

On 10/10/23 at 8:34 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted two unannounced complaint visits in-conjunction. Upon arrival LPA was greeted by receptionist and activites director Chelsea Vandueck. The Executive Director Laura Rodriguez arrive at 9:50 and LPA explained the purpose of the visit. During the initial investigation on 3/14/2023: A physical plant tour and interviews with staff (S1-S2), and resident (R1-R3). The following documents were obtained: Photo of the thermostats, Staff schedule, admissions agreement, Evacuation order, LIC 500 Personnel Report, and resident roster. Report continued on 9099c UnsubstantiatedRead the full finding— CDSS inspection report, October 10, 2023 · control 28-AS-20230307090726

On 10/10/23 at 8:34 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted two unannounced complaint visits in-conjunction. Upon arrival LPA was greeted by receptionist and activites director Chelsea Vandueck. The Executive Director Laura Rodriguez arrive at 9:50 and LPA explained the purpose of the visit. During the initial investigation on 10/03/2023: LPA obtained resident roster, staff roster, R1 admissions agreement, R1’s physicians report, R1’s Hospice plan of care, R1’s resident assessment, R1’s resident information form, R1’s hospice treatment plan, R1’s physicians orders from hospice agency. LPA interviewed: The residential care director and (1) staff who shall be referred to as S1. LPA interviewed a total of ten (10) residents who shall be referred to as: R2 through R11. LPA also interviewed a former resident who shall be referred to as R1. LPA interviewed resident family members and hospice agency who shall be referred to as witness #1 (W1) and witness #2 (W2). LPA isRead the full finding— CDSS inspection report, October 10, 2023 · control 28-AS-20230925081542

Licensing Program Analyst (LPA) Elizabeth Irra conducted a subsequent visit to investigate the above allegations. LPA met with Lilit Chaparyan and discussed the purpose of today's visit. The initial 10-day investigation visit was conducted on 06/30/21 by LPA Linda Almaraz. During this visit, LPA Almaraz conducted a complaint visit to investigate the allegations listed above. LPA met with Administrator, Brittney Buchannan and discussed the reason this visit. The investigation consisted of the following: LPA interviewed the Administrator and attempted to interview former Administrator, Krystal Jenkins, but is no longer an employee at the facility. LPA also attempted to speak to Staff #1 who was not present at the facility. LPA was not able to interview Resident #1 since the resident is no longer at the facility. LPA requested facility staff and resident roster, and Resident #1's file. Refer to LIC 9099C for the continuation of this report. UnsubstantiatedRead the full finding— CDSS inspection report, March 2, 2023 · control 28-AS-20210622103648

Licensing Program Analyst (LPA) Kimberly Ramirez conducted a subsequent complaint visit stemming from initial 10-day complaint visit on 02/17/2022. LPA was met by Staff (S1) and explained the purpose of the visit. The investigation consisted of the following: An inspection of the interior and exterior physical plant was conducted. Staff (S1-S6) and residents (R1- R6) were interviewed. Resident (R1) was not present, and LPA attempted to interview telephonically. LPA requested and obtained the following documents: LIC 500 Personnel Report, Resident roster, Invoices for A/C and heating repair, and invoices for toaster appliance. See LIC 9099C for report continuation. UnsubstantiatedRead the full finding— CDSS inspection report, February 21, 2023 · control 28-AS-20220211102513

***This report supersedes the reports dated on 6/7/22. The allegation - Resident's medication is not being administered, had been reassessed and the finding has been revised from unsubstantiated to substantiated. The other allegations remain substantiated.*** Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent complaint visit to deliver the findings for the above allegations. LPA met with the Executive Director, Lilit Chaparyan, and explained the purpose of the visit. Investigation consisted of the following: On the initial visit dated 1/15/21, LPA conducted a video call to review the food supplies, physical plant, and the medication room. LPA requested copies of the staff roster to include the contact numbers, food menu, and documents for Residents #1 - #5: Physician’s Report, Appraisal/Needs & Services Plan, Hospice and/or facility notes, MAR log for October 2020 through January 2021. SubstantiatedRead the full finding— CDSS inspection report, December 30, 2022 · control 28-AS-20210114084218

Licensing Program Analyst (LPA) Christine Wong conducted a subsequent complaint visit to investigate the above allegations and LPA met with Receptionist Teresa Picos and explained the reason of the visit. Shortly after, LPA met with Business Office Manger Carment Hernandez and Executive Director Lilit Chaparyan and assisted with the visit. The investigation consisted of the following: On 6/28/22, LPA Sicairos obtained copies of Staff & Resident Rosters. LPA reviewed Former Resident #1 (FR1) file and obtained copies of Identification and Emergency Information Sheet, Physician's Report, Admission Agreement, Service Plan, Progress Notes, Resident Appraisal, Admission Orders, and Resident Detail Ledger. LPA interviewed Ms. Mosalla and Staff #1 (S1). On today's visit, LPA Wong interviewed the administrator, 4 staff (S1-S4) and 13 residents (R2-R14) and obtained current staff roster and resident roster. (See LIC 9099C for continuation) UnsubstantiatedRead the full finding— CDSS inspection report, December 20, 2022 · control 28-AS-20220623080038

Licensing Program Analyst (LPA) Bennette Pena conducted a subsequent visit to investigate the above allegation. LPA met with Business Office Director, Nicole Reyes and explained the purpose of today's visit. During the initial visit on 10/10/2022, LPA obtained a copy of the staff/resident roster, work order for the A/C unit and Resident #1 (R1) file, interviewed Resident #1-#4 (R1-R4), Staff #1-3 (S1-3). LPA conducted a tour of the facility which included the front entrance, common areas, hallways, inspected (9) resident rooms (Rooms #103, #108, #112, #114, #115, #117, #123, #127 and #129) and verified thermostat readings.The temperature readings were between 78-80 deg. F which is within Title 22 Regulations. LPA requested copies of the maintenance log for the last 3 months to be sent to LPA's email by end of the business day on 10/11/2022. During today’s visit, LPA continued the interviews with Resident #5-13 (R5-R13), Staff #4-5 (S4-S5), reviewed service reports and work order detailRead the full finding— CDSS inspection report, October 17, 2022 · control 28-AS-20221003120259

On 9/29/2022 at 10:17 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced complaint investigation to the facility. Upon arrival LPA met with Lililit Chaparyan (Executive Director) and explained the purpose of the visit. During today’s visit LPA toured the facility with the executive director and the wellness director (Staff #1), obtained resident/ staff roster, statement from Staff 4 regarding R1, R1’s physician’s orders dated 7/21/2021, 8/24/2021, and 9/29/2022. LPA interviewed residents R1 through R12. LPA Interviewed executive director, Staff S1, S2, and S3. Report continued on 9099C UnsubstantiatedRead the full finding— CDSS inspection report, September 29, 2022 · control 28-AS-20220923154026

Licensing Program Analyst (LPA) David Sicairos conducted an unannounced complaint visit regarding the above stated allegation. LPA met with Sahar Mosalla and explained the reason for the visit. The investigation consisted of the following: LPA obtained copies of Staff & Resident Rosters. LPA reviewed Resident #1 (R1) file and obtained copies of Physician's Report, Appraisal, and ID Emeregency Info Sheet. LPA also interviewed the Administrator, Staff #1 (S1) - Staff #4 (S4) and Resident #1 (R1) - Resident #11 (R11). The investigation revealed the following: in regards to the allegation "resident is being intimidated while in care", it is alleged that there is a male staff member who intimidates residents by staring at them intensely while they are having dinner. The name of the alleged staff member is unknown. 5 out of 5 staff members interviewed denied the allegation. Staff members interviewed denied initimidating any of the residents at the facility or being aware of any other staff mRead the full finding— CDSS inspection report, July 13, 2022 · control 28-AS-20220705131522

Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent complaint visit to deliver the findings for the above three allegations. LPA met with the Director of Assisted Living, Kianny Soto, and Executive Director, Sahar Mosalla, to explain the purpose of the visit. Investigation consisted of the following: On the initial visit dated 1/15/21, LPA conducted a video call to review the food supplies, physical plant, and the medication room. LPA requested copies of the staff roster to include the contact numbers, food menu, and documents for Residents #1 - #5: Physician’s Report, Appraisal/Needs & Services Plan, Hospice and/or facility notes, MAR log for October 2020 through January 2021. On 9/30/21, LPA Chan conducted an on-site visit to interview 4 Staff and 10 Residents. LPA requested for the staff roster, resident roster, and facility notes pertaining to Resident #1. The allegation – Resident is not being rotated resulting in pressure injuries was investigated by an InvestigatRead the full finding— CDSS inspection report, June 7, 2022 · control 28-AS-20210114084218

Licensing Program Analyst (LPA) Vasallo conducted a subsequent complaint visit. LPA met with Business Manager, Carmen Galicia and explained the reason for the visit. The initial complaint visit was conducted by LPA Nina Galarza on 11/10/21. The investigation consisted of the following: During the initial visit, LPA Galarza interviewed Director of Assisted Living, La'Keisha Phillips. During today's visit, LPA Vasallo interviewed 6 staff which included caregiver, Medication Technician's (Med Tech) and front office staff. LPA also interviewed 4 residents. Resident #1's (R1) file was reviewed which included assessments, medication records, progress notes and incident reports. The investigation revealed the following: It's alleged R1 had a change of condition on 10/24/21 and staff failed to call 911 in a timely manner. Facility documented the incident on a report. According to the report, a staff member notified R1's family that R1 appeared to be weak and needed assistance with toileting. CRead the full finding— CDSS inspection report, April 19, 2022 · control 28-AS-20211104142735

Licensing Program Analyst (LPA) Nune Margaryan conducted a subsequent complaint visit to complete the investigation and deliver findings for the allegations listed above. LPA met with Business Manager Carmen Galicia and explain the purpose for today’s visit. The initial visit was conducted by LPA Nune Margaryan on 02/11/22 . During the visit, LPA Nune Margaryan interviewed the Business Manager, Staff #1-4 (S1-S4), and Residents #1-14 (R1-R14). LPA also collected a copies of the staff roster, resident roster, menus for residents food. Continue 9099C Unsubstantiated— CDSS inspection report, April 18, 2022 · control 28-AS-20220203110548