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Inspection visit

Follow-up on corrections

IVY PARK AT SAN JOSELicense 4352028473 citations on this visit
3 citations recorded

Inspector’s narrative

What the inspector wrote

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced case management visit in regards to a phone call the Department received regarding R1 on June 14, 2024. LPA met with Health Services Director (HSD) John Doyle and explained the purpose of the visit. On June 14, 2024, the Department received a phone call from facility Administrator (ADM) Karina Nevarez who stated resident R1 was discovered missing on June 13, 2024 around 9:30pm. ADM stated that R1 was admitted to the facility on March 2024. ADM stated R1's secondary diagnosis is early onset of dementia. ADM stated that the resident likes to sit by the front but is always redirected back. ADM stated R1 resides in the assisted living section of the facility. ADM stated when staff were asked, no one saw R1 leave the facility and have knowledge which door was used by R1 to leave the facility. ADM stated that the family has been notified. ADM stated that SJPD with some facility staff were actively searching for the resident since yesterday and SJPD issued a SILVER ALERT (missing person). The Department received a follow up call from the facility ADM, stating the resident was found was in the hospital since the night before, at 12:10am. ADM stated R1 used the front door and walked to the shopping center near the facility. ADM stated the store clerk contacted 911, when R1 was unable to answer questions about where he/she lived and his/her name. ADM stated R1 stayed in the hospital overnight. ADM stated R1 was going to be transferred to memory care, but they do not have any availability. On June 14, 2024, LPA interviewed HSD. HSD stated the facility has 11 residents with dementia living in the assisted living section of the facility. HSD stated when R1 first moved in he/she would wander to the front or wander up and down the halls. HSD stated once R1 got new friends and joined activities, the wandering went down. Page 1 Out of 2. Based on a review of R1's physicians report dated August 28, 2023, R1 has dementia and cannot leave the facility unassisted. A review of R1's Preplacement Appraisal states R1 has dementia. Under "needs special observation/night supervision (due to confusion, forgetfulness, wandering)", the preplacement appraisal has a question mark between the unchecked yes and no box. Based on a review of R1's progress notes; R1 was noted to pace the floors on May 15, 2024. R1's Progress notes also states R1 was "wandering the halls" on May 16, 17, & 18. A review of R1's Needs and services plan, dated April 1, 2024, under elopement risk status, the form states R1's elopement risk will be evaluated. A review of R1's Elopement Risk Assessment, dated March 28, 2024 states R1 is not able to leave the facility unassisted. An immediate civil penalty of $500.00 is being assessed against the facility today for violation the absence of supervision, which resulted in R1 eloping from the facility overnight. Deficiencies were cited from California Code of Regulations, Title 22 during today’s visit, see LIC 809-D. This report was reviewed with Health Services Director John Doyle and a copy of the report was provided. Appeal Rights was provided. END OF REPORT Page 2 Out of 2.

Citations

3 citations recorded*CCLD

What does Type A vs Type B mean?

Type A. Serious citation. Imminent or substantial risk to children. The regulator requires corrective action immediately and may impose a civil penalty.

Type B. Lower-severity citation. Corrective action required, no imminent risk. The regulator monitors compliance on the next visit.

  • 87405(d)(2)Type A

    Conformance with applicable laws and regulations

    87405 Administrator Qualifications and Duties (d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7)... (2) Knowledge of and ability to conform to the applicable laws, rules and regulations. This requirement is not met as evidenced by: Based on records reviewed and interviews conducted, Administrator did not exhibit the knowledge of applicable laws, rules and regulations resulting in serious violations involving a resident who eloped from facility which poses an immediate health safety and personal rights risk to persons in care.

  • 87468.2(a)(4)Type A

    Right to sufficient care and qualified staff

    87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a)(4) To care, supervision, and services that meet their individual needs ... by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met as evidenced by; Based on interviews conducted, resident R1 had elopped from the facility on June 13, 2024 and staff did not provide R1 with Care and Supervision to met his/her needs. This poses an immideate threat to health, safety or personal rights risk to persons in care.

  • 87705(b)(2)Type A

    Night supervision when dementia residents require it

    87705 Care of Persons with Dementia (b)In addition to the requirements as ... the plan of operation shall address the needs of residents with dementia, including:(2) Safety measures to address behaviors such as wandering, .... This requirement was not met as evidenced by; Based on interviews conducted, licensee did not have plan of operation and safety measures to address the needs of R1 who is diagnosed with dementia and eloped from facility while living in assisted living unit, was supposed to be admitted in dementia unit.

FAQ · About this visit

Common questions about this visit

What happened during the June 14, 2024 inspection of IVY PARK AT SAN JOSE?

This was an other inspection of IVY PARK AT SAN JOSE on June 14, 2024. 3 citations were issued: 3 Type A (serious).

Were any citations issued to IVY PARK AT SAN JOSE on June 14, 2024?

Yes, 3 citations were issued (3 Type A, 0 Type B). The first citation was for: "87405 Administrator Qualifications and Duties (d) The administrator shall have the qualifications specified in Sections ..."

What type of inspection was this?

This was an other inspection. other inspections are conducted by CCLD as part of their licensing oversight.

SourceView on CCLDView original report

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Data from CCLD public records. Last updated . If you believe any information is inaccurate, report it here.