IVY PARK AT BURBANK

Official classification

Type B

Official code

87303(a)(1)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. (1) Floor .... kitchen areas shall be maintained in a clean, sanitary, and odorless condition. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above in having kitchen floors, walls, doors and kitchen appliances such as industrial oven to be clean, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator will ensure that kitchen floors, walls, doors and kitchen appliances have been professionaly cleaned and sanitized and pictures are provided to LPA by the POC date.

Deadline recorded: Oct 31, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87463(f)

Regulation authority

CCR

What the official deficiency says

The licensee shall immediately, or as soon as reasonably possible, communicate with the resident and, if applicable, the resident's representative, about any significant change in condition and the recommendation, if any, of the appropriate licensed medical professional, and if applicable, other specialized care provider. Documentation of such communication shall be added to the resident’s record. This requirement is not met as evidenced by: Based on records review and interview, there was no assessment made to R1 after 2 hospitalizations, this poses a potential health and safety risk to the residents in care.

Official plan of correction

Cleared during visit. An assessment was done on 05/27/25 after CCL's initial visit on 05/21/25.

Deadline recorded: Aug 5, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87208(a)

Regulation authority

CCR

What the official deficiency says

Plan of operation. In part .... The Licensee shall operate the facility in accordance with the terms specified with in the plan of operation. This requirement was not met as evidenced by: Based on information provided by the administrator during the interview S1 did not comply with the facility's medication policy, resulting in repeated medication errors, which poses/posed an immediate health, safety risk to persons in care.

Official plan of correction

Administrator terminated the employment of S1. POC cleared on the date of visit.

Deadline recorded: Apr 17, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

Facility personnel, shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not `met as evidenced by: Based on LPA’s observations, review of facility files and information provided during interviews it was determined that the facility did not provide a sufficient number of staff to meet the needs of residents in care including but not limited to incontinent care, resulting in the risk to the health and safety of residents in care.

Official plan of correction

Administrator will provide sufficient staff to meet resident needs as per CCR 87411(a) and will give LPA copies of staff schedules documenting sufficient personnel to meet the resident needs and copies of required documentation of staff training for existing personnel and any newly hired for the purpose of correcting this deficiency..

Deadline recorded: Feb 19, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468(a)(1)

Regulation authority

CCR

What the official deficiency says

(1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by: Based on the investigation conducted by the Investigative Branch, substantiating sexual assault perpetrated by staff #1 (S1) on Resident #1 (R1) which posed an immediate health and safety risk or personal rights risk to persons in care.

Official plan of correction

S1 was terminated. An immediate civil penalty in the amount of $500 is issued.

Deadline recorded: Feb 19, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. This requirement is not met as evidenced by: Deficient Practice Statement Based on, the licensee did not comply with the section cited above in during annual inspection LPA tested signal system from a resident's bathroom, staff took 30 minutes to clear alarm which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/21/2024 Plan of Correction Licensee will ensure facility has suffiecient staff at all times. As plan of correction, administrator will re-train care staff about the importance of tending in a timely maner the alarms from residents rooms. A proof of training will be sent to LPA via email before POC due date.

Official classification

Type B

Official code

87555(b)(15)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (15) All persons engaged in food preparation and service shall observe personal hygiene and food services sanitation practices which protect the food from contamination. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation), the licensee did not comply with the section cited above in kitchen staff/service staff not wearing hairnets while inside kitchen which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/21/2024 Plan of Correction Licensee will ensure all persons engage in food preparation and service shall observe personal hygene and food services sanitation at all times. As plan of correction, administrator will re-train kitchen and serving staff about the importance of wearing a hairnet while serving food and preparing it. Proof of training will be sent to LPA via email before POC due date.

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident's dementia care needs. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in not having a recent annual evaluation for a resident with dementia/alzheimer's as primary diagnosis which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/21/2024 Plan of Correction Licensee will ensure all residents that has dementia/alzheimer's as primary diagnosis, their annual evaluations are current. As plan of correction, administrator will acquire recent physicians report and file it on resident's file. Proof of recent medical report will be sent to LPA via email before POC due date.

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

(a)Facility personnel shall at all times be sufficient in numbers... In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports....This requirement is not met as evidence by: Based on interviews conducted, residents and staff revealed, residents have waited an unreasonable amount of time to receive assistance citing the number of staff on shift to provide care, which posed an immediate health, safety and personal rights risk to residents in care.

Official plan of correction

Executive Director (ED) stated a job fair is being held July 31st. Facility has hired two caregivers. ED also states staff involved on Wednesday were given final write ups. Facility provided copies of in-service held on various topic including but not limited to individualize service plans and status checks. POC cleared today.

Deadline recorded: Jul 25, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87207

Regulation authority

CCR

What the official deficiency says

87207 False Claims No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility. This requirement was not met as evidence by: Based on a record review and observation. The facility has changed the name on the building, website and is currently advertising under a different name other than what is licensed, prior to approval from licensing. This poses a potential health and safety risk to residents in care.

Official plan of correction

Facility will submit documentation requested in the evaluation report by POC due date. The LIC 200 that was submitted on 01/05/2023 will be reviewed and subject to approval or denial. Documents must be sent on or before POC due date via fax or email.

Deadline recorded: Jan 30, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met as evidence by: The facility failed to meet residents needs by not providing assistance to R1, who had prior falls that the facility was aware of.

Official plan of correction

Licensee shall provide a signed statement to the department that they have read and will comply with this section by the POC date.

Deadline recorded: Dec 23, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement is not met as evidenced by: The facility failed to assist R1 in obtaining a higher level of care than the facility could provide to prevent further falls.

Official plan of correction

Licensee shall provide a signed statement that they have read and will comply with this section and provide additional training to care giving staff and provide proof to the department by the POC date.

Deadline recorded: Dec 23, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(3)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Right of Residents in all Facilities (a) Residents in all residential care facilities… (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of punitive nature… This requirement is not met as evidenced by: Based on investigation report, record reviews and interviews, the licensee reported the resident was found on the toilet for an extended period of time and shaking noted to have marks on buttocks, which poses an immediate health and safety risk to persons in care.

Official plan of correction

The Licensee agreed to review California Code of Regulations Title 22 Section, Division 6, Chapter 8, Article 8. Personal Right of Residents in all Facilities. The Licensee provided in-service training with all staff regarding regulation 87468.1(a)(3) and develop a plan for medical reassessment to ensure resident changes in condition are addressed according and included in the needs/services plan. The Licensee provided the in-service training documents immediately.

Deadline recorded: Oct 8, 2021. A deadline is not proof that correction was completed.