019200922-7-15-2026-15-AS-BFOG-DWGS5D-20260730133406

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019200922
Report Date: 07/15/2026
Date Signed: 07/15/2026 02:15:04 PM

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
02/13/2026 and conducted by Evaluator Patricia Manalo

COMPLAINT CONTROL NUMBER: 15-AS-20260213171042

FACILITY NAME:	IVY PARK AT HAYWARD		FACILITY NUMBER:	019200922
ADMINISTRATOR:	JOSEPH VILLANUEVA		FACILITY TYPE:	740
ADDRESS:	1200 RUSSELL WAY		TELEPHONE:	(510) 727-1700
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94541
CAPACITY:	170	CENSUS: 139	DATE:	07/15/2026
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Joseph Villanueva, Executive Director		TIME COMPLETED:	02:35 PM

ALLEGATION(S):

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Lack of staffing resulting in residents' needs not being met.

INVESTIGATION FINDINGS:

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On 07/15/2026 at 9:10 AM, Licensing Program Analyst (LPA) P. Manalo arrived unannounced to conduct investigation and deliver finding on the above allegation. LPA met with Executive Director (ED), Joseph Villanueva and explained the purpose of the visit.

During the course of the investigation, LPA interviewed ED, 7 staff, 7 residents, Reporting Party (RP), and 3 witnesses.

LPA obtained the following documents including but not limited to Resident Roster, Personnel Report (LIC500), February 2026 Staff Schedule, Staff Contact Information, Residence and Services Agreement, Service Plan, Identification and Emergency Information, Resident Information Form, and Physician Report (LIC602A).

Continue to LIC9099-C…

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Patricia Manalo
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026

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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Control Number 15-AS-20260213171042

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: IVY PARK AT HAYWARD	FACILITY NUMBER: 019200922
	VISIT DATE: 07/15/2026

NARRATIVE

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Allegation: Lack of staffing resulting in residents' needs not being met.

It was alleged that there’s a lack of staffing resulting in residents' needs not being met.

Interviews with ED, S1, and S2 stated that there are at least 5 people during the daytime shifts. S2 stated that if a staff member calls out for their shift, S2 will ask another staff member to pick up an extra shift, or the facility will request from temporary agency to assist with staffing. Interview with S3, S4, S5, S6, and S7 stated that on their floor there is enough staff members to meet the residents’ needs. Interview with S6 also stated that S6 can also assist other staff members with transferring residents if needed. LPA interviewed 7 residents. Interviews with R2, R4, R5, R6, and R7 stated that the amount of staff on the floor are sufficient in providing the care and needs for them and/or their partners that reside in the same room. R4 and R5 stated that the floor could use more staffing for how many residents residing. However, R4 and R5 stated that the number of staff on each shift still meets the needs of the residents and they assist with the residents’ Activities of Daily Living (ADLs). Interviews with W2 and W3 indicated that they visit their family members often and stated that they have observed staff provide services such as dressing, toileting, and/or shower assistance to their family members. Interview with W3 who live in independent Living stated that they are providing and assisting with R6’s ADLs. Based on information obtained from RP, they indicated that there's residents that need three persons assist. However, LPA reviewed R1 and R11’s previous and current service plan that showed both residents need a two person assist when transferring and not three persons assist. A review of the current LIC500 and staff schedule indicates that there is staffing to meet the needs of the residents.

Based on interviews and record review conducted, the above allegation that lack of staffing resulting in residents’ needs not being met is unsubstantiated. 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 allegations are unsubstantiated.

There is no deficiency noted.

Exit interview was conducted with Executive Director and a copy of this report was provided.

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Patricia Manalo
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026

LIC9099 (FAS) - (06/04)

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