Ivy Park at Cerritos.

The investigation reveals the following: Regarding “Staff interacts inappropriately with residents”. It is alleged that staff were taunting R1”. It was found that R1 was referring to the private staff they hired, not the facility staff. The administrator and all staff denied taunting the residents and further stated that none of the residents complained about staff taunting. All residents interviewed denied the allegation. R1 stated that the issues they are having are with the private care staff they hired. The investigation reveals the following: Regarding “Staff speaks inappropriately to resident”. It is alleged that the staff was making fun of and calling R1 names. The administrator and all staff members denied making fun of or calling the residents names. All residents denied the allegation, stating that the staff is wonderful. R1 stated the facility staff is not the issue, but their private care staff is the problem. Based on LPA's interviews, the investigation revealed: Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted with Executive Director Mark Padilla, and a copy of this record was provided.

The investigation reveals the following: Regarding “Staff mismanaged resident's medications”. It is alleged that the facility removed R1’s prescribed Omeprazole and replaced it with a facility-provided version of the medication. It was found that R1 began receiving Omeprazole from the facility pharmacy after the Omeprazole they had moved in with ran out. This caused a change in the manufacturer and the medication's color, which alerted R1. During the file review, LPA determined that R1 consented to using the facilities' pharmacy rather than the pharmacy they had before moving in. R1 stated they don’t want to make any changes to the medication and will continue taking the medication provided by the facility. The administrator and 2 out of 2 staff stated they have given the medication as prescribed and can use another pharmacy if this is what R1 wants. W1 stated that both forms of Omeprazole have the same effect and that they have educated R1 on the topic. 13 out of 14 residents stated they either receive assistance with their medication or take it independently and have no issues with the facility. The investigation reveals the following: Regarding “Staff did not communicate with the resident's responsible party of medication changes”. It is alleged that the facility has been providing the resident with a facility version of their prescribed medication without notifying the resident's responsible party. The administrator and both staff members stated that R1 does not have a Power of Attorney and that they are their own responsible party. They further stated there were no changes in the medication. R1 stated they were not informed of the medication change. File review confirmed that R1 is their own responsible party and that there were no changes to the medication. LPA also confirmed that R1 consented to using the facility pharmacy. 13 of 14 residents stated that the facility always updates them on any changes to their care. Based on LPA's interviews, the investigation revealed: Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted with Administrator Mark Padilla, and a copy of this record was provided.

Investigation revealed the following: in regards to the allegation “Unlawful Eviction”. It was alleged that R1 received 30-day notice and feels R1 is being retaliated against due to complaining about the facility. Interviewed Interim Executive Director stated that Resident 1 (R1) was served an eviction notice due to multiple incidents over the years involving disrespectful behavior toward staff and other residents. Interviewed current Executive Director stated that they joined the Facility on 10/3/25 and was made aware that R1 had been served an Eviction Notice due to behavioral concerns and the concerns had reached a level that the previous leadership felt R1 needed to be removed from the community. However, the Executive Director stated they have developed a positive relationship with R1 and consider R1’s behavior to be manageable. They further indicated that through communication and ongoing relationship-building, the concerns have improved, and the eviction notice was rescinded on 12/01/2025. Interviewed S1 stated they were aware of process of R1’s eviction but new Executive Director established a rapport with R1 and believed he effectively manage R1’s behaviors. Interviewed S2 stated in the past, sometimes R1 could make a comment to the staff and residents, which made them feel uncomfortable. However, under new management, R1 significantly improved and there were no major recent issues. Interviewed S3 stated that R1 is nice, and they didn’t see any behavior from R1 that would make them or others uncomfortable. LPA interviewed 11 residents. R1 denied making negative or disrespectful comments and stated that the incidents listed in the eviction notice were either exaggerated or did not occur. R1 also expressed that the eviction notice may have been issued in response to their raising concerns to administration, such as ensuring doors are locked after hours and maintaining comfortable facility temperatures. (5) out of (10) Interviewed residents stated that they don’t know R1. (5) out of (10) residents stated that they don’t have any issues with R1. Review of the Eviction notice dated 06/25/2025 indicated R1 was served Eviction notice for noncompliance with community policies and house rules regarding disruptive or abusive behavior. Continue 9099C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 The notice referenced a few incidents between 2022 and 2025 involving alleged negative or disrespectful comments. However, upon review of R1’s file, house rules, and eviction documentation, as well as observations and interviews conducted, the LPA did not find sufficient evidence that R1 engaged in behavior that disrupted the facility’s calm, peaceful environment or violated house rules to the extent described, and that R1’s actions violate general facility policies created for the purpose of making it possible for residents to live together as stated under regulation 87224(a)(3). Based on LPA's observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D. Exit interview was held, and a copy of this report, appeal rights were provided.

had anyone working here by the name of Staff S1. Facility Personnel Report does not have the name of Staff S1 listed as having criminal clearance. Staff S2, Staff S3 and Administrator are all listed on the Facility Personnel Report as cleared and associated. Interview with Resident's R1-R12 also stated that no staff have ever taken pictures of them. Based on the information gathered during this visit, the allegation(s) are deemed UNFOUNDED . A finding of UNFOUNDED means that the allegations are either false, could not have happened, and/or are without a reasonable basis. LPA conducted an exit interview with Administrator and a copy of the licensing report was provided during visit.

had anyone working here by the name of Staff S1. Facility Personnel Report does not have the name of Staff S1 listed as having criminal clearance. Staff S2, Staff S3 and Administrator are all listed on the Facility Personnel Report as cleared and associated. Interview with Resident's R1-R12 also stated that no staff have ever taken pictures of them. Based on the information gathered during this visit, the allegation(s) are deemed UNFOUNDED . A finding of UNFOUNDED means that the allegations are either false, could not have happened, and/or are without a reasonable basis. LPA conducted an exit interview with Administrator and a copy of the licensing report was provided during visit.

Licensing Program Analyst (LPA) Daniel Konishi conducted the unannounced required annual inspection. LPA met with the Business Office Manager, Carmen Hernandez and the purpose for the visit was explained. The facility is licensed for the age range 60 and over and 163 non-ambulatory residents. Currently, the facility has six (6) hospice waiver residents and seven (7) home health residents. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control Plan: The facility staff are using appropriate hand hygiene and wearing gloves while assisting residents. Staff are cleaning and disinfecting once a day and more often for high touched surfaces. Facility has sufficient PPE supplies and has an Infection Control Plan in place. Physical Plant and Environmental Safety: LPA toured the facility with the Business Office Manager, Carmen Rodriguez. This property is comprised of one large two-story building on 5.5 acres and contains (90) studio apartments, (42) - 1-bedroom apartments, (12) 2- bedroom apartments, first floor; Lobby/Front desk reception area, administrative offices, Computer room, Salon, Coffee Lounge, Dining room, Kitchen, Community Laundry room, Housekeeping Storage closet, Men/Women restroom, (2) utility rooms. Second floor; Program Director office, Director of Nursing office, Staffing Coordinator office, Medication room, Library, Fitness Center, Theater/Multipurpose room, Men/Women restroom, (4) utility rooms, Storage room (emergency food supplies) and (PPE supplies). The outdoor grounds contained bodies of water in a fountain, 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Physical Plant and Environmental Safety [Cont.]: East Wing Courtyard, West Wing Courtyard and community park. Passageways, walkways, and patios are free from obstructions and hazards. The facility is equipped with central air and heat. LPA inspected 14 residents' rooms and each resident bedroom has the required furniture such as bed frames, dressers, lamps, and chairs. Bedrooms also have sufficient closet space. Resident beds have the required linen, and the linen is in good condition. The bathrooms contain a working toilet, basin, and water faucet, walk in shower with grab bar, skid matt/strips and shower chair. The temperature measured between 110.0 and 117.0-degrees F which is within the Title 22 regulation. The carbon monoxide detectors and smoke detectors are interconnected and all tested and they are all working well. Fire Extinguishers are fully charged. Resident Rights-Information: LPA observed the required posters posted in the facility which include Long Term Care Ombudsman located on the second floor next to the resident's laundry room, and the Community Care Licensing Complaint and Personal Right Poster are located on the first floor near the resident's mailbox. The residents also have internet service for at least one internet access device for residents to communicate with their family members or physicians. Planned Activity: Facility has sufficient space to accommodate for indoor and outdoor activity. LPA also observed the weekly activity calendar and it's posted in the facility. The facility does have an active Resident Council. Food Service: Currently the facility has about three (3) residents who are required to go on modified diet and LPA reviewed and observed the doctor's order. The facility has an ample supply for two days perishable and seven days non-perishable food supply. The facility also has emergency food supplies and water located on the first floor. All the food are stored properly. The kitchen was toured and contained working appliances; refrigerator, stove, oven and contained dishware, cups, plates, utensils, pots, and pans with knives secured and locked. Walls and floors, cabinets and counters were clean and sanitary throughout the facility. Incidental Medical and Dental: LPA reviewed 14 centrally stored resident medications; containing a 30-day supply of medications and no issues were observed. Medical and dental transportation is provided if needed. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Disaster Preparedness: The facility has an updated LIC610E Emergency Disaster Plan. The facility has two alternative shelter location for emergencies. The last fire /disaster drill was conducted on 7/23/2025. LPA also observed the evacuation chair at each stairwell. Due to time constraints, LPA will return at a later date to complete five (5) CARE Tool domains. Per California Code of Regulations, Title 22, and California Health and Safety Code, no deficiencies observed during the visit. An exit interview was conducted and a copy of the report was provided to the Business Office Manager, Carmen Hernandez.

In regards to the allegation that " Staff does not respond to resident’s call button in a timely manner," it is alleged that staff take a long time to assist residents when they use their call pendant. During interviews with the residents, eleven (11) out of twelve (12) interviewed did not corroborate the allegation. One residents stated that the staff are all very responsive to when they use their call signal. Another resident stated that staff do respond to her pendant requests for assistance in a timely manner. During staff interviews, none of them corroborated the allegation. One of the staff interviewed explained that the facility utilized pages, tablets, and radios to respond to the pendant requests. Another explained that if one caregiver is busy assisting a resident, then another caregiver is called to address the resident pendant requests. During record review of the activity report for R1, on 6/30/2025 there was a eighteen (18) minute delay from when the resident used their pendant and when the pendant was cleared, and on 6/29/2025 there was a twenty-four (24) minute delay from the time the resident used the pendant and when it was cleared. All other records of R1's pendant use between 6/24/2025 through 7/3/2025 were fifteen (15) minutes or under. Staff stated that the incident on 6/30/2025 was caused by staff assisting R1 immediately and completely before clearing the pendant on their system. On 6/29/2025 they stated that R1 didn't allow staff to clear the pendant. In regards to the allegation that " Facility did not issue refund to resident's responsible party," it's alleged that R1's family was not provided a refund for the monthly fee of July 2025 when they were discharged from the facility on 7/9/2025 because he needed a higher level of care. During interviews with the residents, none of them corroborated the allegation. Most residents interviewed stated they never had to request a refund from the facility. During interviews with staff, none of them corroborated the allegation. One staff interviewed stated that R1 did not require a higher level of care, and that the facility would be able to retain him, and therefore the residents authorized representative needed to issue a thirty (30) day notice of the termination to receive a refund, as indicated on the admissions agreement. Another staff interviewed also stated that R1 was never taken to a Skilled Nursing Facility or Rehabilitation Center, and was taken to a Board and Care facility that houses residents of similar needs. The staff stated the family will still receive a refund of $628.10. Based on statements and interviews conducted with staff, residents, review of resident files and facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED . Exit interview held, and a copy of this report was provided.

Allegation: Staff retaliates against resident. It is alleged that on June 25, 2025 resident (R1) received a 30-day eviction notice because they expressed concerns regarding the facility to the city council about facility safety. It is also alleged that the licensee has not been responsive to safety concerns such as, unlocked empty rooms and main entrance doors kept unlocked by staff late at night. According to information obtained, when their was a change in ownership the licensee told residents that town hall meetings would be ongoing, and their concerns would be addressed. One (1) out of 11 residents stated administration staff retaliates if residents complain. The majority of the residents had no knowledge of the eviction notice issued to resident (R1). Staff interviews revealed that the eviction notice was issued on June 25, 2025, because in recent months there have been numerous incidents where R1 has become aggressive towards other residents and staff. According to staff, resident (R1) has exhibited unsafe behaviors and broken facility House Rules. Staff denied the allegation. Based on record review, the findings indicate that from April 202 5- to present there have been five incidents of aggressive behavior towards resident and staff. Per House Rules, "Disruptive or abusive behavior by employees, residents, and resident's families or guests is not acceptable or permitted." Therefore, there is insufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated . An exit interview was conducted and a copy of this report was discussed and provided to Interim Executive Director Dina Davis.

In regards to the allegation "Staff do not observe residents for change in condition", it is alleged that R1 has had changes in their condition not observed and addressed by staff. (7) of (7) Staff interviewed denied the allegation. (10) of (10) Residents interviewed could not corroborate the allegation. Staff interviewed stated that R1 and all residents are observed by staff daily. If there are any concerns of changes in their conditions, it is addressed with medical staff. If needed, individual service plans are also updated. Staff interviewed stated that R1's service plan is current and address their needs and services. R1 was not able to express having any issues with their needs and services. Residents interviewed stated that staff are observant of any health issues regarding the residents. File review of R1's needs and services plan shows to have been last updated on 12/7/24. Based on LPA's interviews, observations, and file review the investigation revealed that ; although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. In regards to the allegation "Staff do not assist a resident with grooming" it is alleged that there is a resident who walks around in diapers because staff are not meeting their grooming needs. (7) of (7) Staff interviewed denied the allegation. (10) of (10) Residents interviewed could not corroborate the allegation. Interviews did not show there being a resident who walks around the facility in their diaper. Staff interviewed stated that all residents who need grooming assistance will receive it from staff. LPA was not provided further information about any resident who walks around the facility in a diaper. Based on LPA's interviews, observations, and file review the investigation revealed that ; although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. In regards to the allegation "Staff do not answer residents' call buttons in a timely manner" it is alleged that staff take 30 to 50 minutes to assist R2 when they press their call button. (7) of (7) Staff interviewed denied the allegation. (10) of (10) Residents interviewed could not corroborate the allegation. Staff interviewed stated that R2 is listed as a 2-person assist, meaning there needs to be 2 caregivers available for assisting with mobility when needed. In some instances it may take longer than 10 minutes to get 2 caregivers into R2's room when there are other residents who need assistance as well but it does not take longer than 30 minutes. Residents interviewed did not have issues with the response times of the staff and stated that they arrive in a timely manner. interview with R2 did not state they had issues with the staff response times either. LPA reviewed the call button response times for R2 and observed an average response time of 11 minutes. Based on LPA's interviews, observations, and file review the investigation revealed that ; although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Continued on LIC 9099-C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 In regards to the allegation "Staff did not provide resident with housekeeping services" it is alleged that staff are not cleaning R2's room. (7) of (7) Staff interviewed denied the allegation. (10) of (10) Residents interviewed could not corroborate the allegation. Staff stated that it is facility policy to provide housekeeping services to residents. Rooms are cleaned weekly and any additional assistance can always be requested by the residents. Residents interviewed stated that staff do provide housekeeping services and have no issues with the services. LPA observed housekeeping staff going through residents rooms during the time of the visit. LPA entered R2's room along with other rooms while touring the physical plant and did not observed unattended messes. The facility was clean and in good repair. Based on LPA's interviews, observations, and file review the investigation revealed that ; although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. In regards to the allegation "Staff did not safeguard a resident's personal belongings" it is alleged that a resident had 70 dollars taken from their room due to lack of supervision. (7) of (7) Staff interviewed denied the allegation. (10) of (10) Residents interviewed could not corroborate the allegation. LPA was not provided with specific information regarding who was the resident who had money missing or who could have taken it. Interviews with staff and residents did not provide any names of an individual having 70 dollars taken from them by either staff or another resident. Interviews with staff stated that any reports of missing or stolen items are investigated and local police is contacted. Based on LPA's interviews, observations, and file review the investigation revealed that ; although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview was conducted with Administrator Laura Rodriguez and a copy of this report was provided.

On 9/24/2024, Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced case management visit to follow up on the incident report submitted by the licensee dated 09/16/2024 regarding a staff and a resident. LPA met with Laura Rodriguez, Executive Director and explained the reason for the visit. During the visit, LPA interviewed the Executive Director, Resident #1 (R1) and R1’s responsible party. LPA also obtained copy of residents' census and staff roster. LPA was also informed that Staff #1 was terminated due to the staff #1 actions that did not follow company protocols. The facility has plans of conducting in-service training for current staff. No deficiencies cited during today's visit. Additional follow up may follow. Executive Director Laura Rodriguez was advised, and a copy of this report was given.

The investigation reveals the following: Regarding “Resident was sexually abused while in care”. It is alleged that R1 was sexually assaulted by R2. The Executive Director (ED) stated this is the second time R1 has made this allegation, and it is during the times the facility has construction. The ED further stated R1 claims R2 lives about their room but R2 lives on the other side of the building. 2 out of 2 staff stated R1 and R2 were friends when R2 first moved in. When R2 started to distance themselves from R1 they noticed R1 started making allegations against R2. Staff further stated that there were other allegations R1 made against R2 but R2 was not around R1. 5 out of 11 residents stated R2 is a nice and respectful person. 4 out of 11 residents stated they don’t know R1 or R2. R1 stated in their interviews with IB investigator that someone in the facility is trying to hurt them but would not elaborate. R2 denied the allegation. LPA reviewed IB’s report from Cerritos College Police department. While the police visited there were thumping noises coming from the ceiling and stated R1 stated R2 was in the room because of those noises. R1 also told the police they were assaulted 3-4 times in the past 4 years but R1 was not living in the facility for 4 years at the time. LPA reviewed R1’s medical records and observed R1 has a diagnosis and a history of dementia and confusion. R1 has since relocated to another facility, needing a higher level of care. The investigation reveals the following: Regarding “Staff did not ensure resident had privacy”. It is alleged that R2 sprays themselves through R1’s vent and is listening in on R1’s phone conversation. The Executive Director (ED) denied the allegation stating the residents have their privacy and R2 lives on the other side of the building. The ED further stated staff knocks and wait for acknowledgment 3 times before entering the resident’s rooms. 2 out of 2 staff confirmed the ED’s statement. 10 out 11 residents stated they have enough privacy while living in the facility. Based on LPA's interviews, observation, and file review the investigation revealed that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview was conducted with Laura Rodriguez Executive Director and a copy of this report was provided.

On 8/12/2024, Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced case management visit to follow up on the incident report and SOC 341 submitted by the Executive Director(ED) Laura Rodriguez dated 8/2/2024, regarding a resident and resident altercation. During the visit, LPA interviewed the Executive Director. According to SOC 341 and Incident report, it is alleged that on 8/02/2024, R1 exhibited aggressive behavior towards R2 and R3. R1 tried to sit on the couch between R2 and R3. R2 and R3 tried to tell R1 to hold on so they can make some space. R1 then proceeded grabbed R2 by the arm and let a scratch. Staff was contacted and helped R1 to the room. The ambulance or police was not contacted for the incident. Per ED R1 was had a move out date prior to the incident and the family has opted to move R1 to facility requiring a higher level of care. The facility stated there are no issues at this time. Additional follow up may follow. Executive Director Laura Rodriguez was advised, and a copy of this report was given.

Administrator believes that residents and staff did not get sick from facility's food. She stated that there was an outbreak and LA County Public Health got involved. LA County Public Health determined that there was a norovirus outbreak based on some stool collected and tested. Administrator stated that their first case was Resident 1 (R1). Resident 1 (R1) vomited in the dining room on 04/08/2024. After this incident, many residents and staff started getting sick. Administrator stated R1 was not showing any symptoms until R1 vomited in the dining room. Administrator believes this incident might have been the beginning of the norovirus outbreak, but LA County Public Health was not able to determined the cause of the norovirus. LPA reviewed the LA County Public Health list of all the residents and staff that got sick and observed a total of 32 residents and 18 staff. R1's date of onset illness was 04/08/2024 and everyone else is either 04/10/2024 or after. The LA County Public Health Nurse assigned to this outbreak stated that the case was assigned to her on 04/11/2024 and it was determined that it was a norovirus outbreak based on test results from some stools they collected. The nurse also stated that unfortunately they were not able to determined the source of this outbreak and this case was closed on 04/25/2024. LPA conducted a tour of the kitchen on 04/18/2024 and today, and did not observed any concerns with the food. Staff interviewed believe they got sick from providing care to the residents that were sick and not from eating the facility's food. Residents interviewed did not provide any information that indicated that the facility's food was the cause of the sickness. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Exit interview held and a copy of the report was provided

The investigation revealed of the following: Allegation#1 “Licensee did not ensure pre-admission appraisal was done correctly.” It is alleged that the facility told R1's family that R1 requires more care than the facility can provide and the facility told R1's family to hire an outside agency to provide additional care while the family is looking for a new care home for R1. LPA interviewed 13 residents and all denied the allegation and indicated the facility is able to provide the assistance that residents required and needed. LPA interviewed the staff and denied the allegation and stated before resident move in to the facility, the facility would complete a pre-appraisal assessment along with the primary care physician report and review resident’s medication and also see if resident is under fall risk or not. They would also complete a 30-day assessment after resident move in and communicate with the families and see if the resident required full assistance. Based on the documents reviewed, the facility completed the resident’s appraisal and a comprehensive health and service evaluation with needs and service plan for R1. The facility also assessed R1’s fall risk and the level of care. In addition, the facility tried to accommodate residents’ needs and let R1’s family stay with the resident during the transition period. Allegation#2 "Facility did not issue the correct refund amount." It is alleged that R1 should have been refunded more than what the facility provided upon leaving the facility. LPA reviewed R1's financial records and conducted interviews with staff. R1's record review revealed that the facility charges a $3500 community fee. However, R1 received promotional offer which waived $2000 of that initial fee, therefore R1's family only paid a $1500 community fee upon moving in on 05/07/2022. The monthly charges for May 2022 was scheduled to be $3207, however R1 only lived at the facility for two weeks, therefore paid a prorated amount of $2762 for the month instead. Per the Admission Agreement signed by R1's family, they were entitled to an 80% refund of the community fee which equaled to $1193. In addition the facility agreed to provide a "miscellaneous fee" in the amount of $310 to R1's family which was not required per the Admission Agreement. In conclusion, R1's paid a total of $6707 but was refunded $4265. There was no evidence obtained during the investigation indicating that R1's family should have received a larger refund. Based on statements and interviews conducted with staff and residents and documents reviewed, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit Interview Conducted. A copy of the report was provided to the Executive Director Laura Rodriguez.

The investigation revealed: Allegation: Staff do not maintain facility at a comfortable temperature for resident. It is alleged that resident did not have heat for over a week, that it is 69 degrees F in R1 room. LPA interviewed 5 total staff including 2 maintenance technicians and 5 of 5 staff denied the allegation. The technicians stated that the have had many work orders due to R1 complaining about the temperature in R1 room and that after inspecting the room, it has been confirmed that R1 thermostat is functioning properly. The facility also provided 2 portable heaters to provide R1 with alternative heat due to R1 insisting that R1 room heat is not working and alleging that is it blowing cold air. LPA was in R1 room for some time measuring the temperature in R1 room. The temperature was 82 degrees at the time of measurement and felt warmer than that to LPA. LPA did not notice or feel any cold air coming from the vent as alleged. LPA checked temperatures throughout the facility, and it measured 72.8 degrees in the facility sample room #145. It was 75.3 degrees in hallway adjacent to room 117. LPA along with Laura Rodriguez Executive Director checked the temperatures in rooms 116, 117,119,123, 125, 120, 127, 129, and 246 and they measured between 73.9 degrees F to 78.0 degrees F which is within regulatory range. LPA interviewed 13 residents and 13 of 13 could not collaborate the allegation. Mostly all the residents stated that the temperature in the rooms are comfortable, and they have no complaints. 2 residents stated that the cold goes through the window in their rooms, but stated the room is comfortable. One resident stated the heat goes through the window in room. LPA suggested to Laura Rodriguez Executive Director to follow up with the 3 residents’ window issues to check if windows have failed. LPA tested the thermostat in R1 room, and it was operating properly. R1 had stated that one of R1 portable heaters was not working. LPA, Laura Rodriguez Executive Director , and S2 verified that it was working and S2 instructed R1 on how to operate it. On initial visit on 12/22/2023, LPA suggested that facility make R1 physician aware of R1 concerns about feeling very cold most of the time while in R1 room. Facility did follow-up with R1 physician right away and tests were order and results pending. LPA obtained invoice from Specialty A/C that confirms that the A/C-Heating unit in room 117 is working properly. Facility has also offered to move R1 but R1 refused. LPA did not find any evidence to substantiate the allegation. Based on LPA's interviews, observation, and file review the investigation revealed that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview was conducted with Laura Rodriguez Executive Director and a copy of this report was provided .

The investigation reveals the following: Regarding “Staff are not maintaining a comfortable room temperature for resident”. It is alleged that R1’s room is very hot in the summer and very cold during the winter. The Executive Director denied the allegation stating each resident have an individual unit that they can control, if the A/C unit is not working the resident can put in a work order and received a portable unit if needed. The Executive Director further stated R1’s A/C unit is operational and has been inspected by two (2) A/C companies who found no issues. 2 out of 2 staff denied the allegation stating all the A/C units work and they respond right away. 10 out of 13 residents stated their system work and they call for assistance whenever they want to change it. 1 out of 13 residents stated their A/C unit is not working but was given portable A/C unit until the repairs are made. 1 out of 13 residents stated their A/C unit is not operational. LPA’s reviewed A/C invoices and confirmed the A/C units are operating normally. Based on LPA's interviews, observation, and file review the investigation revealed that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview was conducted with Laura Rodriguez Executive Director and a copy of this report was provided.

During today’s visit LPA interviewed Executive Director Laura Rodriguez and delivered findings for the investigation. The investigation reveals the following: Regarding " Staff did not assist resident with ADLs.”. It is alleged that the facility does not assist with the residents’ activities of daily living (ADL). LPA interviewed Executive director Laura Rodriguez and Resident Care Director, Martha Altamira, who denied the allegation stating the facility assist’s residents with ADLs. They further stated residents are reassessed every resident quarterly to ensure their needs are met. 1 out of 1 staff stated the facility assists residents with their ADL’s. 8 out of 10 residents stated the facility helps them with their activities of daily living or they do not need assistance with their activities of daily living. 1 out 10 residents stated the facility was not assisting with their activities of daily living. 1 out of 10 residents stated the facility was not assisting ADL’s. The investigation reveals the following: Regarding " Staff did not meet resident's needs.”. It is alleged that the facility is not meeting the needs of the residents. LPA interviewed Executive Director Laura Rodriguez and Resident Care Director, Martha Altamira, who denied the allegation stating the facility has always met the needs of the residents. 8 out of 10 residents denied the allegation stating the facility has always met their needs. 2 out of 10 residents stated the facility was not able to meet their needs. Based on LPA's interviews, investigation revealed: Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted with Laura Rodriguez and a copy of this record provided.

On 9/14/23 at 9:22 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced Annual Continuation visit at Ivy Park Cerritos. Upon arrival LPA was greeted by Executive Director Laura Rodriguez. This home is licensed to serve (163) non-Ambulatory residents ages 60 and over, with a hospice waiver for 10. The last emergency disaster/fire drill was conducted on 8/23/23. The Administrator Certificate expired on 3/4/2021 #6051234740. LPA observed that the administrator certificate is processing and is currently on the pending list. During today's visit LPA reviewed (5) staff files, (13) resident files, medications, and medication administration records for (13) residents. LPA inspected the medications and observed PRN medications for resident R1 through R5 was missing. Med staff stated they will review all resident’s medication and discontinue or reorder the medication. · R1 is missing Diphenoxylate, Diclofenac, Lidocaine, and Loperamide. · R2 is missing I Prat- Albuterol and Novolin R 100. · R3 is missing Alprazolam and Milk of magnesia. · R4 is missing Hydrocodone with Acetaminophen · R5 is Missing Acetaminophen 500, Bisacodyl, Geri-Lanta, and Robafen The following Deficiencies were cited on the LIC809D. Exit interview conducted with Laura Rodriguez, Executive director a copy of this report was provided, and Appeal rights given.

On 8/15/23 at 9:30 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced Annual/Required inspection to Ivy Park Cerritos. Upon arrival LPA was greeted by Executive Director Laura Rodriguez the reason for the visit. This facility is licensed to serve 163 residents age 60 and over with non-ambulatory capacity of 163. The facility currently has an approved hospice waiver for 10. During today's visit LPA inspected the physical plant inside and outside, reviewed the food supply, tested the smoke/carbon monoxide detectors, interviewed (5) staff, and interviewed (10) residents. LPA toured the physical plant with the Executive Director Laura Rodriguez and Regional Health Services Specialist Adriana RuizThis property is comprised of one large two story building on 5.5 acres and contains (90) studio apartments, (42) - 1-bedroom apartments, (12) 2- bedroom apartments, first floor; Lobby/Front desk reception area, administrative offices, Computer room, Salon, Coffee Lounge, Dining room, Kitchen, Community Laundry room, Housekeeping Storage closet, Men/Women restroom, (2) utility rooms. Second floor; Program Director office, Director of Nursing office, Staffing Coordinator office, Medication room, Library, Fitness Center, Theater/Multipurpose room, Men/Women restroom, (4) utility rooms, Storage room (emergency food supplies) and (PPE supplies). The outdoor grounds contained body of water in a fountain, East Wing Courtyard, West Wing Courtyard and community park. Passageways, walkways, and patios are free from obstructions and hazards. The facility is equipped with central air and heat. The resident’s bedrooms have the required furniture such as bed frames, dressers, lamps, and chairs. Bedrooms also have sufficient closet space. Resident beds have the required linen, and the linen is in good condition. The bathrooms contain a working toilet, basin, and water faucet, walk in shower with grab bar, skid matt/strips and shower chair. The temperature measured at 105 *F- 120*F. The smoke detectors were tested and observed to be working properly. The carbon monoxide detector was functioning properly. There were fire extinguishers located throughout the facility, fully charged and up to date. The kitchen was toured and contained working appliances; refrigerator, stove, oven and contained dishware, cups, plates, utensils, pots, and pans with knives secured and locked. The pantry was well stocked, and the food supply contained a sufficient supply with a two-day supply of perishables and a seven-day supply of non-perishables that met title 22 guidelines. Walls and floors, cabinets and counters were clean and sanitary throughout the facility. (Report continued on LIC809C.) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Upon return LPA will review medications, review staff and resident files, review staff training, and finalize care tools. Exit interview conducted with Laura Rodriguez and Adriana Ruiz, a copy of this report was provided.