IVY PARK AT CERRITOS

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

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.