019200722-7-5-2024-15-AS-KHOS-D9EMXH-20240924095957

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200722
Report Date: 07/05/2024
Date Signed: 07/05/2024 09:51:40 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/24/2024 and conducted by Evaluator Alona Gomez

COMPLAINT CONTROL NUMBER: 15-AS-20240624122903

FACILITY NAME:	IVY PARK AT PLEASANTON		FACILITY NUMBER:	019200722
ADMINISTRATOR:	TRACY BURKE		FACILITY TYPE:	740
ADDRESS:	5700 PLEASANT HILL RD		TELEPHONE:	(925) 416-0238
CITY:	PLEASANTON	STATE: CA	ZIP CODE:	94588
CAPACITY:	103	CENSUS: 80	DATE:	07/05/2024
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Business Office Director, Ena Vilao		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Facility didn't provide resident's records as requested

INVESTIGATION FINDINGS:

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On 7/05/2024 at 8:30 AM, Licensing Program Analyst (LPA) A Gomez arrived unannounced to conduct a complaint investigation and deliver findings in regard to the allegations above. LPA met with Business Office Director, Ena Vilao.

During the visit LPA spoke with Business Office Director (BOD) who contacted the Executive Director. BOD informed LPA all requested documents were not sent out on 6/24/2024. Requested documents were due in 2 business days and facility received the request 6/20/2024. LPA obtained copies of receipt of proof for sent documents.

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.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) -28-0517
LICENSING EVALUATOR NAME: Alona Gomez	TELEPHONE: 510-239-1306
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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