Ivy Park at San Lauren

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Sarah Hurt conducted an unannounced visit today for the facility’s annual inspection. LPA met with Facility Administrator Paul Anderson, Continual Administrator's Certification expires 03/29/2028. There are currently 67 residents who reside at this home and there is 7 residents on hospice at this time. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, activity rooms, medication storage, kitchen, and outdoor areas. Bedrooms were clean and in good repair. There is a locked storage for medications. Food supply is adequate for 2-day perishable and 7-day nonperishable. Fire extinguisher is within the safety regulation period. Smoke alarms were tested and are operational. The home has a carbon monoxide detector and performs disaster drills as required. First Aid kit is on site and complete. Toxins and cleaning supplies are locked and inaccessible. LPA observed hot water in facility model bedroom measured to be 122.9 degrees. Resident 1's Centrally stored medication record is not accurate. The following deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22. LPA requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing. Exit interview conducted with Facility Administrator Paul Anderson and copy of report left at facilitythe state’s words, verbatim · CDSS document, Jun 8, 2026

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Case Management - Deficiencies

On June 16, 2025, Licensing Program Analyst (LPA) Rachel Bruce conducted an unannounced case management visit at the above facility for the purpose of discussing a recent incident report. On June 12, 2025, an incident report was submitted to CCL regarding a resident who recently eloped from the facility . On June 12, 2025 a resident (R1- see confidential names list attached) left her bedroom by way of the window. After removing the screen R1 climbed out and wandered to property adjacent to the facility at approximately 6:00 AM. R1 then contacted her family who in turn contacted the facility who verified she was not in her room. Staff immediately returned her to the facility and arranged for one on one care until it is determined that she is no longer an immediate risk to elope. A medical appointment is scheduled for this week to determine what if any medical factors are affecting her behavior. The family has been to the facility and understands the action taken and has no immediate concern over the care she is receiving. The facility has also installed new window 'warden locks' on all memory care windows. R1 had removed the previous window lock but the new ones are metal and should not be as easily removed. Discussion was had regarding the night staff and room checks. The NOC shift previously would do room checks every two hours. Since this incident room checks have been changed from every 2 hours to every hour. A citation under Title 22 is being issued at today's visit. The plan of correction has already been put in place and will be cleared at today's visit as well. See attached deficiency page.the state’s words, verbatim · CDSS document, Jun 16, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 80078(a) · Plan of correction due date: Jun 16, 2025

Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the client's needs. This requirement was not met as evidenced by R1 eloped out of her bedroom window and subsequently called her family to inform them she had 'gotten out'. R1 was immediately returned to the facility. Elopement poses an immediate risk to the health and safety of residents.the state’s words, verbatim · CDSS document, Jun 16, 2025

Plan of correction: Facility has installed new locks on the resident bedroom windows and regarding R1 have arranged one on one care until further notice. Plan of correction will be cleared at today's visit.

Allegation investigated: Resident has not received a shower for an extended period of time

On 5/8/2025, Licensing Program Analyst (LPA) Rachel Bruce conducted a subsequent complaint investigation visit to the facility. During the course of this complaint investigation LPA interviewed staff and residents and obtained and/or reviewed facility records. It was determined based on the interviews and records review that the above allegation is SUBSTANTIATED. Facility did not have hot water available to residents for over 7 days during February 2025. During this time residents had no access to their regular shower and although there was one shower available in another unit, many residents did not know and/or did not feel comfortable so many residents went without a proper shower until the units were repaired. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. See attached citation. An exit interview was conducted with Administrator, a copy of this report with plan of corrections, and appeal rights were provided. Substantiatedthe state’s words, verbatim · CDSS document, May 8, 2025 · control 24-AS-20250211120402

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(2) · Plan of correction due date: May 8, 2025

Personal Rights 87468.1 (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by Shower equipment (hot water) was not available and functioning for several days and residents who were not informed of alternative had to do without taking a shower. This poses a potential risk to the health and safety of the residents in care.the state’s words, verbatim · CDSS document, May 8, 2025

Plan of correction: The water issue was fixed under the prior administrative team. Showers and hot water are available and have been since repair was completed. The POC will be cleared as of today's visit.

Type of visit: Required - 1 Year

On 03/27/25, Licensing Program Analysts (LPAs) L. Salazar and M. Garza arrived to the facility unannounced to conduct the required Annual Inspection visit. LPAs were greeted by Administrator, stated the purpose of the visit and were allowed entry into the facility. Administrator on record is Doug Rice, Certificate #6053032740, Exp. 07/15/2025. Facility census on this visit is 41 in Assisted Living and 23 in Memory Care. There are currently four residents receiving Hospice services and 5 residents are receiving Home Health Care services. A tour of resident bedrooms were observed to have the required lighting and furnishings and were free from odor and any passageway obstruction / fire hazards. Facility temperature was 71 degrees F. LPA observed the required postings for Non-discrimination, Personal Rights of Residents in RCFE (87468.1 and 87468.2), Complaint Poster and facility's visitation policy. Bathrooms were toured and observed to have operational lights, running water, and non- slip floors and required furnishings. Call system was observed to be operational. Hot water temperature tested at 118 degrees F. Cleaning supplies were observed to be locked in a janitorial closet located in Memory Care. LPA toured the kitchen observed the required 7-day supply of non-perishable food and 2- day supply of fresh perishables to be properly stored. Menus for the facility were observed. Carbon monoxide detectors were observed to be operational. Fire Extinguishers throughout the facility were observed with a service date of 02/14/25. First aid kits were observed. Medications were observed to be locked in Med cart located in a staffed locked medication room. Quarterly Emergency Disaster Drill logs were observed for staff, last drill was 02/17/25. A sample of resident and staff files were reviewed by LPA Garza and will be documented on a separate report. An exit interview was conducted with Administrator. A copy of this report was discussed and provided at the time of visit. No deficiencies cited on today's visit.the state’s words, verbatim · CDSS document, Mar 27, 2025

Type of visit: POC

On 03/27/25, Licensing Program Analysts (LPAs) L. Salazar and M. Garza arrived to the facility unannounced to conduct a Plan of Correction visit from the 02/29/25 complaint visit. LPAs were greeted by Administrator, stated the purpose of the visit and were allowed entry into the facility. Facility has developed a memo draft that will be modified to accommodate any building issue that residents need to be aware of that will effect their daily living. Meetings will be documented and attendance noted, and information provided will be distributed to those not present. This will ensure that residents are made aware of physical plant issues, what is being done to remedy the issue and what is being done to mitigate the impact. Updates will be provided as necessary as issues are remedied. Sample memo provided at today's visit. This POC from the 02/19/25 is cleared.the state’s words, verbatim · CDSS document, Mar 27, 2025

Type of visit: Case Management - Annual Continuation

On 3/27/2025 Licensing Program Analysts (LPAs) M. Garza and L. Salazar arrived for an unannounced Case Management visit. This case management visit is being conducted for the purpose of an annual continuation visit. LPAs met with Executive Director, Douglas Rice, explained reason for visit and were permitted entry into the facility. A tour of the facility was conducted inside and out. A health and safety check was completed on residents in care. Residents were observed in dining area, rooms and common areas. LPAs reviewed sample of resident files. 3 of 6 resident files reviewed had the required/completed documentation. 3 of 3 resident files reviewed were missing updated TB testing. No exception observed for these files. LPAs reviewed sample staff files. 3 of 5 staff files reviewed had the required/completed documentation. TA provided for resident and staff files. Exit interview completed with Executive Director, Douglas. A copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 27, 2025

Allegation investigated: Facility was without hot water in the residential section of the builiding.

On February 19, 2025, Licensing Program Analyst (LPA) Rachel Bruce conducted a subsequent complaint investigation visit to the facility. During the course of this complaint investigation LPA interviewed staff and residents on duty and obtained and/or reviewed facility records. It was determined based on the interviews and records review that the above allegation is SUBSTANTIATED. Facility did not did not have hot water available to residents for over 7 days. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8 Article 5 is being cited on the attached LIC 9099D.”) Refer to Case Management dated February 19, 2025 for an additional deficiency. An exit interview was conducted with Administrator, a copy of this report with plan of corrections, and appeal rights were provided. Substantiatedthe state’s words, verbatim · CDSS document, Feb 19, 2025 · control 24-AS-20250211103342

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(a) · Plan of correction due date: Feb 19, 2025

Maintenance and Operations: (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidenced by Hot water system was not functioning and resdients were without access to hot running water in their units. This poses a potential risk to the health, safety and personal rights of the resdients in care.the state’s words, verbatim · CDSS document, Feb 19, 2025

Plan of correction: Facility has developed a memo draft that will be modified to accomodate any building issue that residents need to be aware of that will effect their daily living. Meetings will be documented and attendance noted, and information provided will be distributed to those not present. This will ensure that residents are made aware of pysical plant issues, what is being done to remedy the issue and what is being done to mitigate the impact. Updates will be provided as necessary as issues are remedied. Sample memo provided at today's visit. POC will be cleared at today's visit.

Type of visit: Case Management - Incident

On 09/25/24, Licensing Program Analysts (LPAs) L. Salazar and M. Medina arrived at the facility unannounced to conduct a case management visit based on a self reported incident. LPAs were greeted by Administrator, stated the purpose of the visit and was allowed entry into the facility. On 09/11/24, facility submitted an incident report for Resident R1. LPAs requested copies of R1's Physician's Report, Needs and Service Plan, Personnel Summary, and Death certificate. All documents were obtained except for the Death certificate, which has been ordered. LPA will review documents and return at a later date if needed. LPAs toured the facility during the visit to observed the new flooring that was recently completed. No deficiencies cited on today's visit.the state’s words, verbatim · CDSS document, Sep 25, 2024

Type of visit: Case Management - Annual Continuation

On 05/29/24, Licensing Program Analyst (LPA) L. Salazar arrived at the facility unannounced to conduct an annual continuation to conduct record reviews. LPA was greeted by ED, stated the purpose of the visit and was allowed entry into the facility. LPA reviewed a sample of records for residents and staff. Resident records were found to be complete and contain the required documentation. Staff files were observed to be complete with updated training records. No deficiencies cited on today's visit.the state’s words, verbatim · CDSS document, May 29, 2024

Type of visit: Case Management - Incident

On 05/29/24, Licensing Program Analyst (LPA) L. Salazar arrived at the facility unannounced to conduct a case management visit on an incident that occurred. LPA stated the purpose of the visit and was allowed entry into the facility. On 05/21/24, Resident R1 had a physical altercation with Resident R2 in the memory care unit. The altercation was broke up by staff and Hospice was called for R1's aggressive behavior. R1 was given a PRN for agitation and R2 received first aid treatment. R1 was put on 72 hour chart monitoring for observation. R2 had no complaint of pain. Both families were notified about the incident. There have been no incidents since then. No deficiencies cited.the state’s words, verbatim · CDSS document, May 29, 2024

Type of visit: Required - 1 Year

On 05/02/24, Licensing Program Analyst (LPA) L. Salazar arrived to the facility unannounced to conduct the required annual inspection, LPA was greeted by Administrator, stated the purpose of the visit and was allowed entry into the facility. Administrator on record is Doug Rice, Certificate #6053032740 Exp. 07/15/2025. Facility census on this visit is 39 residents in Assisted Living and 28 residents in Memory Care. There are currently 10 residents receiving Hospice services and 4 residents are receiving Home Health Care services. A tour of resident bedrooms were observed to have the required lighting and furnishings and were free from odor and any passageway obstruction / fire hazards. Facility temperature was 71 degrees F. LPA observed the required postings for Non-discrimination, Personal Rights of Residents in RCFE, Complaint Poster and facility's visitation policy. Cleaning supplies were observed to be locked in a janitorial closet located in Memory Care. LPA toured the kitchen observed the required 7-day supply of non-perishable food and 2- day supply of fresh perishables to be properly stored. Menus for the facility were observed. Carbon monoxide detectors were observed. Fire Extinguishers throughout the facility were observed with a service date of 04/01/24. First aid kits were observed to contain all required items. LPA obtained facility roster (LIC 9020) and Personnel Summary (LIC500). Due to time restraint, LPA will review and return to facility to complete records review. No deficiencies cited on today's visit. An exit interview was conducted with Administrator and a copy of this report were provided at the time of visit.the state’s words, verbatim · CDSS document, May 2, 2024

Allegation investigated: Resident sustained multiple pressure injuries due to staff neglect Resident sustained injury due to staff handling resident in a rough manner Staff did not seek medical attention for resident Staff did not allow hospice to come and provide care for resident Staff are not providing adequate food service for resident Staff left resident in soiled diapers for an extended period of time Staff are not responding to resident's call button Staff did not ensure resident had access to call button

On 01/03/2024, Licensing Program Analyst, (LPA) L. Salazar arrived to the facility unannounced to deliver findings on the above allegations. LPA was greeted by Administrator, stated the purpose of the visit and was allowed entry into the facility. During the investigation, LPA toured Resident R1's room and observed them sleeping in their bed, with call button and phone in hand. LPA reviewed facility staff response time in the call log records to be adequate and timely. LPA conducted interviews with family, facility staff and Hospice nurse. LPA reviewed R1's facility file, facility communication logs and Hospice care notes. R1 has been on Hospice care since 2022, and has had a continued decline in their health. Hospice records show R1 sleeps 18+ hours a day, has a decreasing appetite and eats 25 – 50% of meals per day, often refusing to eat. Documentation shows on multiple occasions, that R1 did not want to be touched and did not want the caregivers to change their briefs. LPA observed the facility to be in compliance with their assigned duties and responsibilities per the agreed Hospice care plan. Based on the information received, the complaint allegations are Unfounded, meaning that the allegations are false, or are without reasonable basis, therefore, we have dismissed the complaint. Exit interview conducted with Administrator and a copy of this report was provided at the time of visit. Nothe state’s words, verbatim · CDSS document, Jan 3, 2024 · control 24-AS-20231003124747