Ivy Park at Seven Oaks

Allegation investigated: Staff failed to prevent residents from engaging in a physical altercation which resulted in injuries

On 11/09/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct a subsequent complaint visit and deliver finding on the above allegation. LPA introduced self, announced the purpose of the visit, and met with Administrator Pamela Bradley. During the course of the investigation, interviews were conducted, and records were reviewed. Staff were present and intervene to stop the physical altercation between R1 and R2. Based on records reviewed and interviews which were conducted, the preponderance of evidence standard has not been met, therefore, the above allegation is found to be UNSUBSTANTIATED. An exit interview was conducted. A copy of this report was provided to Administrator, whose signature on this report confirms receipt of this report. Unsubstantiatedthe state’s words, verbatim · CDSS document, Nov 9, 2023 · control 24-AS-20231024142901

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Illegal Eviction.

On 11/09/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct a subsequent complaint visit and deliver finding on the above allegation. LPA introduced self, announced the purpose of the visit, and met with Administrator Pamela Bradley. During the course of the investigation, interviews were conducted, and records were reviewed. R1 had a doctor’s order for R1 to be hospitalized. R1’s doctor and R1’s family were working on an alternative placement. Placement was found for R1. Based on records reviewed and interviews which were conducted, the preponderance of evidence standard has not been met, therefore, the above allegation is found to be UNSUBSTANTIATED. An exit interview was conducted. A copy of this report was provided to Administrator, whose signature on this report confirms receipt of this report. Unsubstantiatedthe state’s words, verbatim · CDSS document, Nov 9, 2023 · control 24-AS-20231024161209

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Illegal eviction.

On 11/01/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced to deliver finding on the above allegation. LPA introduced self, announced the purpose of the visit, and met with Health Service Director (HSD) Annette Eggleston. During the course of the investigation, interviews were conducted and records were reviewed. Interviews were conducted and records reviewed confirm R1’s son requested the facility to deny the resident back to the facility from the hospital. Based on records reviewed and interviews which were conducted, the preponderance of evidence standard has not been met, therefore, the above allegation is found to be UNSUBSTANTIATED. An exit interview was conducted. A copy of this report was provided to the HSD, whose signature on this report confirms receipt of this report. Unsubstantiatedthe state’s words, verbatim · CDSS document, Nov 1, 2023 · control 24-AS-20230928144808

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Office

A virtual office meeting was conducted on this date. The purpose of the informal meeting was to discuss recently identified issues/concerns associated with the operation of the facility. The informal meeting process was explained during this meeting. The following were in attendance: Pamela Anderson, Administrator Kevin Wrigley, Senior Regulatory Director See Moua, Licensing Program Manager Mai Yang, Licensing Program Analyst The following concerns were addressed: Resident’s admission agreement Administrator shall submit additional documents to the department regarding care services change specifically Companion Care charges. Exit interview was conducted. Administrator was provided a copy of this report. Signed report on file.the state’s words, verbatim · CDSS document, Oct 12, 2023

Type of visit: Case Management - Other

On 09/12/23, Licensing Program Analyst (LPA) M. Yang conducted case management visit to the facility. LPA introduce self, stated the purpose of the visit, and met with Administrator/ Executive Director Pamela Bradley. The purpose of today's visit is to follow up on information that was received at the Community Care Regional office regarding facility did not provide resident 1 (R1) refund for community fee and refund fee. Copies of records were reviewed and received. Interview were conducted. Based on records reviewed and interview conducted, R1 reside at the facility for over 90 days after the community fee refund contract prorated basis. No refund issued to the resident; the resident has a remaining balance for services provided for the companion care. No deficiencies issued. An exit interview was conducted. A copy of this report was provided to Administrator/ Executive Director, whose signature confirms receipt of this report.the state’s words, verbatim · CDSS document, Sep 12, 2023

Allegation investigated: Staff refused to allow resident to return to facility after hospital stay

On 07/24/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced and conducted an initial complaint investigation. LPA met with Administrator/ Executive Director Pamela Bradley. LPA discussed the allegation and finding with Administrator. The allegation that staff refused to allow resident to return to facility after hospital stay was addressed on a case management on 07/18/23. This complaint is SUBSTANTIATED for the record and was cited under California Code of Regulations, Title 22, Division 6, Chapter 6 on 07/18/23 during case management visit. An exit interview was conducted. A copy of this report was provided to Administrator, whose signature confirms receipt of this report. Substantiatedthe state’s words, verbatim · CDSS document, Jul 24, 2023 · control 24-AS-20230719162657

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Case Management - Deficiencies

On 07/24/23, Licensing Program Analyst (LPA) M. Yang conducted an unannounced case management- deficiency inspection regarding written incident report received from facility on 07/21/23. LPA met Administrator/ Executive Director Pamela Bradley. The purpose of the today's visit is to follow up on the incident that occurred on 07/20/23. At 08:20 AM on 07/20/23, staff administered R1 the wrong medication. Staff immediately notified Memory Care Director. A deficiency is being cited, per California Code of Regulations, Title 22, Division 6, see attached Lic 809D. Exit Interview conducted. A copy of this report and appeal rights was provided to the Administrator.the state’s words, verbatim · CDSS document, Jul 24, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(5) · Plan of correction due date: Jul 25, 2023

87465(a)(5) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by: Based on interview, R1 was administered R2’s medication by S1 which poses an immediate health and safety risks to persons in care.the state’s words, verbatim · CDSS document, Jul 24, 2023

Plan of correction: S1 was retrained on administering medication on 07/20/23. LPA received copies of S1 in-service training and documentation. POC cleared during visit.

Type of visit: Case Management - Deficiencies

On 07/18/23, Licensing Program Analyst (LPA) M. Yang conducted case management deficiency visit to the facility. LPA introduce self, stated the purpose of the visit and met with Administrator/ Executive Director Pamela Bradley The purpose of the visit is to address incident that occurred where R1 went AWOL on 07/10/23. Therefore, as mentioned, R1 went AWOL from facility. As a result, a deficiency is being cited, per California Code of Regulations, Title 22, Division 6, see attached 809D. A deficiency is being cited, per California Code of Regulations, Title 22, Division 6, see attached Lic 809D. An exit interview was conducted. A copy of this report and appeal rights was provided to Administrator/Executive Director, whose signature confirms receipt of this report.the state’s words, verbatim · CDSS document, Jul 18, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87413(a)(2) · Plan of correction due date: Jul 19, 2023

87413(a)(2) a) In each facility: (2) Care and supervision of residents shall be provided without physical or verbal abuse, exploitation or prejudice. This requirement is not met as evidenced by: Based on interview and record review, staff did not provide care and supervision when memory care R1 left the facility unsupervised on 07/10/23 at approximately 07:35PM. The facility was not aware R1 went AWOL until approximately at 07:47 PM when the facility was notified by the neighboring building that the resident was in their building lobby. This poses an immediate health and safety risks to persons in care.the state’s words, verbatim · CDSS document, Jul 18, 2023

Plan of correction: Licensee shall submit a plan detailing steps the facility will take to ensure the requirements are met by 07/19/23. Licensee has agreed to submit AWOL in-service training and rooster of staff attendance to the Department by 08/01/23.

Allegation investigated: Facility failed to notify residents that pendant alarms were not working

On 3/6/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an initial 10-day inspection. LPA introduced self, stated the purpose of the visit and met with Administrator/ Executive Director Pamela Bradley. During the course of the investigation, LPA received copy of records, toured the facility and conducted interviews. Facility pendant alarm were not working on 02/23/23. Facility notified alarm vender and supervisors immediately. The residents were notified the same day of the alarm system not working on 2/23/23. A written notification was sent to the residents’ responsible party and residents on 2/27/23. Based on the observation, records reviewed, and interviews that were conducted the above allegation is founded to be UNSUBSTANTIATED due to facility has notified the resident within 24 hours of the alarm system not working and took the proper measure to ensure the safety of the residents. An exit interview was conducted, a copy of this report was provided via email to Administrator. Report signed on-site. Unsubstantiatedthe state’s words, verbatim · CDSS document, Mar 6, 2023 · control 24-AS-20230228141933

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Facility did not follow resident's admission agreement.

On 3/6/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced to deliver complaint finding on the above allegation. LPA introduced self, stated the purpose of the visit, and met with Administrator/ Executive Director Pamela Bradley. During the course of the investigation record were reviewed and interview were conducted. Admission agreement was not updated to reflect the hours of one-on-one that the resident needed. The total charges that the facility was providing the responsible party did not agree nor sign to the charges. In additional there is no updated physician report or assessment that the resident needed a 24 hour one-on-one care. Based on record reviewed and interview conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Under California Code of Regulations, Title 22, are being cited on the attached LIC 9099D. Plan of correction was discussed. An exit interview was conducted, and a copy of this report and appeal rights was provided to via email to Administrator. Substantiatedthe state’s words, verbatim · CDSS document, Mar 6, 2023 · control 24-AS-20230217121216

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(g)(3)(B)(1) · Plan of correction due date: Mar 31, 2023

Admission agreements shall specify the following: (3) Payment provisions, including the following: (B) Rate for additional items and services, including: 1. A comprehensive description of and the corresponding fee schedule for…items and services not included in the fees for basic services shall be listed. This requirement was not met by: Based on interview and records reviewed, the one-on-one charges were not outlined and not agreed by responsible party or resident in the admission agreement. The resident was charged for one on one 24-hour champion care which possess a potential health and safety and personal rights risk to the resident in care.the state’s words, verbatim · CDSS document, Mar 6, 2023

Plan of correction: Facility administrator agrees to resend an updated bill statement that excludes the one-on- one 24 hour champion care charges to resident and resident’s responsible party. Copy of the updated bill statement shall be submitted to CCL by 3/31/23. Any additional services included one-on-one care, admission agreement shall be updated with description and total of services fee that charged signed and approved by resident or responsible party.

Type of visit: Prelicensing

On 01/09/23, Licensing Program Analyst (LPA) M. Yang arrived announced to conduct a follow-up Pre-Licensing inspection/ Component III Inspection. LPA introduced self, stated the purpose of the visit, and met with Pamela Bradley, Executive Director. LPA toured facility with Executive Director and Annette Eggleston, Health Service Director. LPA observed medications and all sharps removed from residents’ room inaccessible to residents. LPA observed cleaning chemicals stored and locked in shelf. Component III was conducted during today's follow-up pre-licensing visit. LPA found that the applicant has met all pre-licensing requirements. LPA will submit documentation to CAB in Sacramento and notify Licensing Program Manager for final review prior to license being issued. Exit interview conducted. An exit interview was conducted. A copy of this report was provided to Executive Director.the state’s words, verbatim · CDSS document, Jan 9, 2023

Type of visit: Prelicensing

On 12/28/22, Licensing Program Analyst (LPA) M. Yang conducted an announced Pre-licensing / Component III Inspection. LPA introduced self, stated the purpose of the visit, and met with Executive Directory Krystal Jenkins. The facility is a 164 bedroom of which 116 bedrooms is in assisted living and 48 bedrooms is in memory care. Fire clearance is granted by the local Fire Department for 156 non-ambulatory and 8 bedridden for total capacity of 164. LPA conducted a tour inside and outside of the facility. The following areas were toured and inspected: 1st Floor: Administration offices, Front Lobby, Mail Room, Fitness Center, Laundry Room, Supply Room, Private Dining Room, Dining Area, Medication Room, Kitchen, Lounge room, Activity rooms, and a sample of rooms. 2nd Floor: Hair Salon, Laundry Room, Lounge room, Medication Room, Gym, Theater, Supply room, and a sample of rooms. Memory Care: Laundry Room, Dining room, and Activity room, and a sample of bedrooms. LPA observed bathrooms to be functioning properly with grab bars. Bathrooms temperature range from 108.2 to 109.4 degree in Assisted Living and 108.4 to 110.5 degree in Memory Care. Food supply was checked and appeared to be an adequate supply. Refrigerator temperature maintained at 40-degree F and Freezer temperature maintained at 0-degree F. Emergency exits are posted. A fire extinguisher observed in every hallway and observed with service date of 10/10/22. First Aid kit located at facility front desk, kitchen and medication rooms with required items. Medications were kept locked and inaccessible to residents in care in medication room. A sample of resident records were reviewed. LPA observed resident Admission Agreements, Pre-Appraisal, and Physician Reports. A sample of staff records were reviewed to have a criminal record clearance and good health screening. The following will need to be brought into compliance: 1. All bathroom shower need to a non-skid mat or strip. 2. All medications shall be stored and locked inaccessible to residents in care. 3. All cleaning chemicals shall be stored and locked inaccessible to residents in care. 4. All sharps shall be stored and locked inaccessible to residents in care. Licensee to contact LPA within 30 days to conduct a follow-up inspection. An exit interview was conducted, and list of corrections were discussed. A copy of this report was provided to Executive Director.the state’s words, verbatim · CDSS document, Dec 28, 2022

Type of visit: Office

Component II completion: Successful Facility Type: Residential Care Facility for the Elderly (RCFE) Application Type: Change in Ownership (CHOW) Capacity: 164 Census (if any clients in care): 72 COMP II Participants: Krystal Jenkins, Administrator Interview Method: Telephone interview On December 9, 2022, Administrator participated in COMP II. Identification of the Administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, Administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. During COMP II, CAB Analyst confirmed Administrator’s understanding of following areas: 1. Facility Operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing Requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General Provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing Readiness Exit interview conducted with Administrator. Report sent via email PDF to Administrator and informed to return signed copy by end of business today.the state’s words, verbatim · CDSS document, Dec 9, 2022