Ivy Park at Cerritos

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.

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.

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**.

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.

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.

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.

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.

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.

(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.

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.

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.

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.

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.

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.

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.

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.

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.

87468.1Personal Rights of Residents in All Facilities(a)Residents in all residential care facilities for the elderly shall have all of the following personal rights: 10) To be informed of the licensee’s policy concerning visits and other communications with residents, according to Health and Safety Code section 1569.313. This requirement is not met as evidenced by: LPAs did not obseve PINS in front lobby area on 7/14/2021 and on 8/11/2021. 6 out of 6 residents have stated that they do not know what PINS are and the the facility does not provide PINS to residents. Which poses a potential health and safety risk to persons in care.

Definitions (c) "Care and supervision" means the facility assumes responsibility for, or provides or promises to provide in the future, ongoing assistance with activities of daily living without which the resident’s physical health, mental health, safety, or welfare would be endangered. Assistance includes assistance with taking medications, money management, or personal care. This requirement is not met as evidenced by: Based on interviews, 4 out of 6 resident pendants were not responded to at time of pendant test. 2 out of 6 residents stated that pendants are not responded to for more than 20 minutes. Based on Record review, Device Activity Report was reviewed, and it was revealed that on 7/14/2021, there were 31 instances with a response time of, or more than 20 minutes.Which poses an immediate health and safety risk to persons in care.