IVY PARK AT GLEN COVE

Official classification

Type B

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

87468.1(a)(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement not met by Licensee as evidence by: Based upon observations and interviews, R1 was not ensured clean and comfortable accomodations which poses/posed a potential risk to the Health, Safety and Rights of residents in care.

Official plan of correction

Licensee shall submit plan on ensuring resident accomodations are clean and laundered by Plan of Correction due date of 8/10/2026 by 5:00PM.

Deadline recorded: Aug 10, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87464(f)(4)

Regulation authority

CCR

What the official deficiency says

87464(f)(4) Personal assistance and care as needed by the resident... with those activities of daily living such as dressing, eating, bathing... This requirement not met by Licensee as evidenced by: Based upon file review and interviews, R1 was not bathed as required by care plan which poses/posed a potential risk to the Health, Safety and Rights of residents in care.

Official plan of correction

Licensee shall submit proof of training regarding showering and documentation by Plan of Correction due date of 8/10/2026 by 5:00PM.

Deadline recorded: Aug 10, 2026. 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

87465(c)(2) Once ordered by the physician the medication is given according to the physician's directions. This requirement not met by Licensee as evidenced by: Based upon file review and interviews, R1 was not dispensed medication according to the physician's directions which poses/posed an immediate risk to the Health, Safety and Rights of residents in care.

Official plan of correction

Licensee shall submit a plan on how they will ensure medication is filled and dispensed as prescribed by Plan of Correction due date of 7/13/2026 by 5:00PM.

Deadline recorded: Jul 13, 2026. 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

Personnel Requirements – General 87411(a) 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 interviews and file review, facility did not provide supervision to R1 resulting in an elopement. The absence/lack of supervision is an immediate risk to the Health, Safety and Rights of residents in care.

Official plan of correction

Licensee has conducted in-service retraining to staff on elopement protocols. Deficiency cleared at time of visit.

Deadline recorded: May 12, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated, in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in 4 of 15 resident records. Reappraisals were not updated within the last 12 months, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/19/2025 Plan of Correction Licensee agrees to review resident care plans and make updates as needed. Licensee shall submit Self Certification that resident reappraisals have been completed. Self Certification shall be subitted to CCLD by 12/19/2025.

Official classification

Type B

Official code

87468.2(a)(2)

Regulation authority

CCR

What the official deficiency says

Additional Personal Rights of Residents in Privately Operated Facilities 87468.2(a)(2) To have their records and personal information remain confidential and to approve their release, except as authorized by law. This requirement not met by licensee as evidenced by: Licensee did not dispose of confidential resident records in a secure manner which poses a potential health, safety, or personal rights risk to persons in care.

Official plan of correction

Licensee to conduct staff training on proper disposal of confidential material in order to protect residents personal rights. Licensee to submit proof of training to CCL by COB on Plan of Correction due date of 11/14/2025.

Deadline recorded: Nov 14, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(d)

Regulation authority

CCR

What the official deficiency says

87464(d) Basic Services: A facility need not accept a particular resident for care. However, if a facility chooses to accept a particular resident for care, the facility shall be responsible for meeting the resident's needs...This requirement is not met as evidenced by: Based on LPAs observations, interviews conducted and pictures received. Staff did not ensure resident R1 was clean and dry and did not meet their needs. This poses an immediate Health, Safety or Personal rights risk to residents.

Official plan of correction

Facility agrees to send in written statement on how they will meet regulation and proof of staff training in Memory care unit. Written statement due 9/30/2024 and proof of staff training focusing on incontinent needs by 10/4/2024 Attention LPA Canela

Deadline recorded: Sep 30, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303(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: Facility failed to keep R1s bedroom clean, and odor free. This is a potential risk to resident in care.

Official plan of correction

Facility to send in written plan on how they will stay in compliance and proof of staff training. POC due date 10/11/2024 attention LPA A Canela

Deadline recorded: Oct 11, 2024. 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(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... This requiement was not met as evidenced by: Based on staff interviews and records reviewed: Facility did not ensure supervision of R2 and R3, who AWOL'd from the facility without their knowledge. R2's & R3's Physician's Report(LIC 602) states diagnoses of Dementia & they may not leave the facility unassisted. This is an immediate risk to the health and afety of residents care.

Official plan of correction

Facility to send in written plan on how they will ensure that residents do not leave the facility unassisted. Facility to train all staff regarding Care and Supervision, AWOL procedures. Staff training to include date, time of day, duration, subject, names and signatures of staff who attended. Written Plan and staff training to be submitted to Community Care Licensing (CCL) by POC due date 07/30/2024 Civil Penalty for $500.00 was issued during today's visit for Zero Tolerance, Absence of Supervision.

Deadline recorded: Jul 31, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303(a) Maintenance and Operation- (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: Residents room had an issue with mice in their closet/room. no mice dropping were observed in the kitchen. This is a potential risk to the health & Safety of residents in care.

Official plan of correction

Facility called pest control and took care of the pest issue. Facility provided copies of pest contract invoice, to clear deficiency.

Deadline recorded: Jul 31, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(A)

Regulation authority

CCR

What the official deficiency says

87211(a)(1)(A)Reporting Requirements (a)Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident name.............; attending physician's name, findings, and treatment, if any; and disposition of the case. (A) Death of any resident from any cause regardless of where the death occurred, including but not limited to a day program, a hospital, en route to or from a hospital, or visiting away from the facility. This requirement was not met as evidenced by: The facility failed to report several incidents and the Death report in November 2023 for resident R1. This is a potential risk to the health & safety of residents in care

Official plan of correction

Facility to submit missing incident reports. Death report was provided during todays visit. Facility to send in written plan on how facility will ensure care coordinator/facility staff will send in required reports timely. New administrator to provide proof all staff have been trained in reporting requirements. Written Plan of correction due 5/15/24 & staff training due 5/17/2024

Deadline recorded: May 17, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

87705(f)(2)Care of Persons with Dementia(f) The following shall be stored inaccessible to residents with dementia:(2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. This requirement was not met as evidenced by: During the inspection of 2/2/2024 LPA found, cleaning solution, hammer, knife and cup of vitamins accessible to resident R1 and R2. This is an immediate risk to the health and safety of residents in care.

Official plan of correction

Facility to send in written statement on how they will stay in compliance. POC due date 3/5/2024 to LPA A Canela

Deadline recorded: Mar 4, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87355(e)(b)

Regulation authority

CCR

What the official deficiency says

87355(e)(b) Criminal Record Clearance(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility:(2) Request a transfer of a criminal record clearance as specified in Section 87355(c) This requirement was not met as evidenced by: during the inspection of 2/2/2024, LPA discovered staff S1 who was working, had been fingerprinted, but previous Administrator forgot to properly associate S1 to this facility. This is a potential risk to the health and safety of residents in care.

Official plan of correction

Facility immediately processed paperwork to associate S1. Facility to send in written statement on how they will stay in compliance and ensure all new staff and current staff are fingerprint cleared and properly associated to this facility prior to working or volunteering. POC due date 3/5/2024 to LPA A Canela

Deadline recorded: Mar 5, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

87463(a) REAPPRAISALS. The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate…*** Based on statements and documents, this requirement has not been met as evidenced by: RI’s condition significantly changed since 5/2/2023 appraisal and now requires substantial bed rest due to pressure injury. No update to R1’s appraisal has been made. This poses a potential risk to R1’s health and safety.

Official plan of correction

Administration agrees to produce an updated care plan for R1. Administration to provide a copy of the updated plan to CCL by POC date in order to clear the deficiency.

Deadline recorded: Aug 17, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(5)

Regulation authority

CCR

What the official deficiency says

87465(a)(5): Incidental Medical and Dental Care Services. The licensee shall assist residents with self administered medications when needed. This requirement is not met as evidenced by: Based on self reported incident and interview with Administrator the facility failed to ensure R2's medication was given as prescribed by doctor. Staff found R2 had 2 Fentanyl patches at one time, staff failed to remove one of the patches before applying another one, which poses an immediate health and safety risk to resident in care.

Official plan of correction

Administrator had already conducted medication training and provided proof to LPA to clear citation repeated CITATION $250.00

Deadline recorded: Jun 6, 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(a) Personnel Requirements-Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. Based on review of incident report and interview with Administrator, this requirement has not been met as evidenced by: Resident R1 left the facility on two occasions, one being at 9pm at night, without the facility knowing or R1 signing out. This is an immediate risk to the health and safety of residents in care. This requirement is not met

Official plan of correction

Facility to ensure R1 plan of care is updated to reflect an AWOL alert POC date 6/6/2023. Caregiver staff to be trained in AWOL protocols/procedures by 6/15/2023- in addition facility to obtain a new medical assessment LIC602 for resident R1 and send in to CCL LPA A Canela when received .

Deadline recorded: Jun 6, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.269(a)(6)

Regulation authority

HSC

What the official deficiency says

1569.269(a)(6) Enumerated rights; severability(a)Residents of residential care facilities for the elderly shall have all of the following rights:(6) 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 was not met as evidenced by: Facility failed to ensure resident R1 was assisted with their oral, self care needs and plan to ensure injuries are assessed. This is an immediate risk to the health and safety of residents in care.

Official plan of correction

Facility to send in a written plan on how they will ensure residents are assisted with activities of daily living, that a plan is incorporated to meet their needs and that staff follow. Facility to conduct staff training. Written plan due 2/8/2023 and staff training due by 2/14/2023 attention LPA Araceli Canela by FAX or email.

Deadline recorded: Feb 8, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)

Regulation authority

CCR

What the official deficiency says

87211(a)((1)Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: 1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. This requirement was not met as evidenced by: facility failed to report R1's arm injuries to family and Community Care Licensing , within 7 day. This is a potential risk to resident in care

Official plan of correction

Facility to send in written plan on how they will ensure they meet requlation. POC due date 2/16/2023

Deadline recorded: Feb 16, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(2)To be accorded safe, healthful and comfortable accommodations...This requirement was not met as evidenced by: Based on LPA’s observations, the Licensee did not comply with the Department of Public Health and Department of Social Services Guidelines and Requirements related to COVID-19. LPA received corroborating ionformation some visitors are not all screened mainly on the weekends or are not hand santizing an being screened for COVID related symptoms. This poses an immediate health and safety risk to residents in care.

Official plan of correction

Facility to submit a written plan to CCL on how they will ensure that COVID procedures will be followed by 12/16/2022 and facility to provide In-service Training stating that Facility has read and understood COVID procedures based on current Public Health and Social Services Departmental guidelines. written plan POC due date 12/16/2022 and proof of training POC due date 12/26/2022 Attention LPA Araceli Canela

Deadline recorded: Dec 16, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

874119(d)

Regulation authority

CCR

What the official deficiency says

874119(d)Personnel Requirements - General(d) All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following, as appropriate for the job assigned and as evidenced by safe and effective job performance: This requirement was not met as evidenced by: Investigation and corroborating statement showed, staff S2 did not have all the required training. This is a potential risk to the health and Safety of residents in care.

Official plan of correction

Facility to to send in written plan they understand requirements and how they will ensure it is being met. POC due date 12/23/2022 to LPA Araceli Canela

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

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465(a)(4): Incidental Medical and Dental Care Services. (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on record review, and interview w/Care Coordinator S4 & Administrator. The facility failed to ensure R1's medication was provided as prescribed by doctor when Staff S3 told R1 they were out of medication and could not provide, additional staff located medication an hour and a half later and staff S3 had made a mistake. This poses an immediate health and safety risk to resident in care.

Official plan of correction

Facility administrator will submit proof of in service medication training and written statement on how they will ensure all staff providing medication are fully trained. POC due date for written statement due, 8//10/2022 and proof of training by 8/19/2022 To LPA A. Canela

Deadline recorded: Aug 10, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(5)

Regulation authority

CCR

What the official deficiency says

87465(a)(5): Incidental Medical and Dental Care Services. The licensee shall assist residents with self administered medications when needed. This requirement is not met as evidenced by: Based on record review, and interview with Administrator the facility failed to ensure R1's medication was given as prescribed by doctor when S1 accidentaly gave R1 medication for a resident with the same name (R2) which poses an immediate health and safety risk to resident in care.

Official plan of correction

Facility administrator incorporated the use of the medication cart, will submit proof of in service medication training POC due date,7/20/2022 To LPA A. Canela

Deadline recorded: Jul 20, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87217(b)

Regulation authority

CCR

What the official deficiency says

87217(b)Safeguards for Resident Cash, Personal Property, and Valuables.(b) Every facility shall take appropriate measures to safeguard residents' cash resources, personal property and valuables which have been entrusted to the licensee or facility staff. The licensee shall give the residents receipts for all such articles or cash resources. This requirement was not met as evidenced by: Investigation revealed R1's electric shaver was reimbursed to R1 after facility could not locate. This is a potential risk to residents in care

Official plan of correction

Facility to send in written plan. By POC due date 10/30/2021

Deadline recorded: Oct 30, 2021. A deadline is not proof that correction was completed.