IVY PARK AT CERRITOS

Official classification

Type B

Official code

87224(a)(3)

Regulation authority

CCR

What the official deficiency says

The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5).Thirty (30) days written notice to the resident is required except as otherwise specified in paragraph (5).(3)Failure of the resident to comply with general policies of the facility. Said general policies must be in writing, must be for the purpose of making it possible for residents to live together and must be made part of the admission agreement. This requirement is not met as evidenced by: Eviction Notice dated 06/25/25 does not indicate how R1's actions violate general facility policies created for the purpose of making it possible for residents to live together.

Official plan of correction

Cleared during visit. Eviction notice was rescinded on 12/01/25.

Deadline recorded: Mar 19, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87202(a)(2)

Regulation authority

CCR

What the official deficiency says

Fire Clearance All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department...Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department... This requirement is not met as evidenced by: Deficient Practice Statement The facility license was approved to retained 163 non-ambulatory and hospice approved for 25 residents and currently LPA observed based on record review of Resident#13 (R13) physician’s report and observation that R13 is (1) bedridden resident at the facility. This poses an immediate health, safety or personal rights risk to persons in care. **Immediate civil penalty will be assessed**.

Official plan of correction

POC Due Date: 08/01/2025 Plan of Correction Licensee will notify the local fire department/Fire Marshall today that the facility is retaining one (1) bedridden resident without a bedridden fire clearance. Licensee will submit LIC 200, facility sketch, and identify the rooms for bedridden resident(s) to the licensing department immediately no later than 08/01/2025.

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

(1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, LPA observed that Staff #3 (S3), Staff #4 (S4), Staff #5 (S5) and Staff #6 (S6) did not have valid first aid training in file which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/14/2025 Plan of Correction Executive Director will send Staff #3 (S3), Staff #4 (S4), Staff #5 (S5) and Staff #6 (S6’s) valid first aid training to the LPA by the POC due date. Daniel.Konishi@dss.ca.gov

Official classification

Type B

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health. Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, Staff #1 (S1’s) file did not have an TB test result which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/14/2025 Plan of Correction Executive Director will send Staff #1 (S1’s) TB test result to the LPA by the POC due date. Daniel.Konishi@dss.ca.gov

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

(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 record review, LPA observed that Resident #6 (R6’s) file with Dementia did not have an updated medical assessment which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/14/2025 Plan of Correction Executive Director will submit Resident #6 (R6's) updated medical assessment to the LPA by the POC due date. Daniel.Konishi@dss.ca.gov

Official classification

Type B

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health.Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, LPA observed one staff does not have health screening and TB test result and one staff does not have the TB test result which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/02/2024 Plan of Correction The administrator will ensure all staff would have the health screening and chest x ray performed by a physician not more than 6 months prior to seven (7) days after employment or licensure. The administrator will send their health screening form and chest x ray to LPA by POC due date.

Official classification

Type B

Official code

87705(5)(A)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia (5) Each resident with dementia shall have an annual medical assessment…and a reappraisal done…(A)When…observation indicates that the resident’s needs have changed, corresponding changes shall be made in the care and supervision provided to that resident. This requirement was not met as evidenced by: Based on record review and interviews, the Licensee failed to update R1's Physician's Report and Appraisal to indicate that R1 was now a fall risk, which poses a potential Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

Licensee will submit a plan in writting on how they will ensure to update resident records as needed, especially if a change in condition is observed. Plan to be emailed to LPA by POC due date.

Deadline recorded: Apr 26, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87463(a)(3)

Regulation authority

CCR

What the official deficiency says

87463 Reappraisals (a) The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate...(3) Any illness, injury, trauma, or change in the health care needs of the resident that results in a circumstance or condition specified in Sections 87455(c) or 87615, Prohibited Health Conditions. This requirement was not met as evidenced by: Based on interviews and record review, the Licensee failed to update R1's appraisal to document that R1 was repositioning R1's self after staff were repositioning R1 that led to R1 sustaining a Stage III ulcer while in care, which poses a potential Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

Licensee will submit a plan in writing on how facility will esnure to document all resident changes in condition to prevent prohibited health conditions.

Deadline recorded: Apr 20, 2024. 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

(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. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services. This requirement was not met as evidence by: Based on interviews 8 out of 10 residents stated due to the lack of staff they have had to wait an hour or more for their food, which poses an potential health,safety, or personal rights risk to persons in care.

Official plan of correction

The facility will ensure there are sufficent staffing in the kitchen to provide residents meals in a timely manner. Facility Administrator stated they are working on stream lining the kitchen services and hired new kitchen staff. The facility will provide training to all kitchen staff and send training to LPA by POC due date.

Deadline recorded: Oct 31, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care Services. Once ordered by the physician, nonprescription PRN medications shall be given in accordance with the physician’s directions. This requirement is not met as evidenced by: Based on observation, PRN medications was missing without a discontinued order, which poses an immediate health, safety, or personal rights risk to persons in care.

Official plan of correction

The facility will ensure that Residents have PRN medications ordered by the physician available at the facility at all times. Medication staff stated they will review all resident medications and discontinue or reorder the medications. Supporting documents will be required as proof of completion to LPA by POC due date.

Deadline recorded: Sep 15, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(a)(1)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility... (1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement is not met as evidenced by: Based on record review and interviews, R-1 was not taking the insulin injection on a daily basis which poses a health and safety risk to residents in care.

Official plan of correction

The administrator shall develop a plan to ensure that residents who have injection medications are taking them as prescribed. The plan shall also include the steps the facility will take when a resident health condition declines or refuses. This POC is due by 1/13/23.

Deadline recorded: Jan 13, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(a)(2)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility....(b) (2) The licensee shall provide assistance in meeting necessary medical and dental needs... This requirement is not met as evidenced by: Based on record reviews and interviews, the administrator did not ensure that Resident #1 was rotated frequently to prevent the wound from worsening which poses a potential health and safety risk to residents in care.

Official plan of correction

The administrator shall conduct an in-service training with care staff to ensure they are repositioning residents at least every 2 hours. The POC shall be submitted to LPA by 1/13/23. **The civil penalty previously issued had been paid.***

Deadline recorded: Jan 13, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87625(b)(2)

Regulation authority

CCR

What the official deficiency says

87625 Managed Incontinence (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (2) Ensuring that incontinent residents are checked during those periods of time when they are known to be incontinent, including during the night. This requirement is not met as evidenced by: Based on interviews and record review, the administrator did not ensure that Resident #1's diaper is changed often to keep buttock area dry which poses a potential health and safety risk to residents in care.

Official plan of correction

The administrator shall conduct an in-service training with care staff to ensure they are repositioning residents at least every 2 hours. The POC shall be submitted to LPA by 12/30/22. **This deficiency has been cleared.**

Deadline recorded: Dec 30, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(7)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements (b) The following food service requirements shall apply: (7) Modified diets prescribed by a resident's physician as a medical necessity shall be provided. This requirement is not met as evidenced by: Based on interviews, the administrator did not ensure that Resident #1 is not provided with orange juice as stated on the hospice notes which poses a potential health and safety risk to residents in care.

Official plan of correction

The Administrator will continue on-going training for staff to ensure residents' needs are met and what residents cannot have. The POC shall be submitted to LPA by 12/30/22. **This deficiency has been cleared.***

Deadline recorded: Dec 30, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(a)(2)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility....(b) (2) The licensee shall provide assistance in meeting necessary medical and dental needs... This requirement is not met as evidenced by: Based on record reviews and interviews, the administrator did not ensure that Resident #1 was rotated frequently to prevent the wound from worsening which poses a potential health and safety risk to residents in care.

Official plan of correction

The administrator shall conduct an in-service training with care staff to ensure they are repositioning residents at least every 2 hours. The POC shall be submitted to LPA by 6/21/22.

Deadline recorded: Jun 21, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87625(b)(2)

Regulation authority

CCR

What the official deficiency says

87625 Managed Incontinence (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (2) Ensuring that incontinent residents are checked during those periods of time when they are known to be incontinent, including during the night. This requirement is not met as evidenced by: Based on interviews and record review, the administrator did not ensure that Resident #1's diaper is changed often to keep buttock area dry which poses a potential health and safety risk to residents in care.

Official plan of correction

The administrator shall conducted an in-service with care staff to ensure they are changing residents' diapers as often as needed. The POC shall be submitted to LPA by 6/21/22.

Deadline recorded: Jun 21, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(7)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements (b) The following food service requirements shall apply: (7) Modified diets prescribed by a resident's physician as a medical necessity shall be provided. This requirement is not met as evidenced by: Based on interviews, the administrator did not ensure that Resident #1 is not provided with orange juice as stated on the hospice notes which poses a potential health and safety risk to residents in care.

Official plan of correction

The Administrator will continue on-going training for staff to ensure residents' needs are met and what residents cannot have. The POC shall be submitted to LPA by 6/21/22.

Deadline recorded: Jun 21, 2022. A deadline is not proof that correction was completed.