019201324-7-2-2025-15-AS-KHOS-DJENTZ-20250709104534

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019201324
Report Date: 07/02/2025
Date Signed: 07/02/2025 11:14:26 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
04/09/2025 and conducted by Evaluator Ardalan Gharachorloo

COMPLAINT CONTROL NUMBER: 15-AS-20250409151315

FACILITY NAME:	IVY PARK AT PLEASANTON		FACILITY NUMBER:	019201324
ADMINISTRATOR:	MARTINEZ, DIANE DIEM		FACILITY TYPE:	740
ADDRESS:	5700 PLEASANT HILL ROAD		TELEPHONE:	(925) 416-0238
CITY:	PLEASANTON	STATE: CA	ZIP CODE:	94588
CAPACITY:	103	CENSUS: 89	DATE:	07/02/2025
		UNANNOUNCED	TIME BEGAN:	10:05 AM
MET WITH:	Gilbert Castro, Executive Director		TIME COMPLETED:	11:40 AM

ALLEGATION(S):

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Staff are interfering with resident's visitation

INVESTIGATION FINDINGS:

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On 07/02/2025 at 10:05 AM, Licensing Program Analyst (LPA) Ardalan Gharachorloo arrived unannounced to deliver findings regarding the allegation above. LPA met with the Executive Director, Gilbert Castro and explained the purpose of the visit.

Allegation: Staff are interfering with resident’s visitation – Unsubstantiated.

During the course of the investigation, LPA interviewed four staff members (S1–S4), three residents (R1–R3), and (W1). LPA also reviewed R1’s file including the admission agreement, physician’s report, care plan, charting notes, communication logs, and Power of Attorney documents.

The review of records revealed that, the admission agreement contained no provisions authorizing restrictions on visitation such as requiring staff presence, location limitations, or advance notice. Charting notes and communication logs did not reflect any instructions to restrict access to R1.

***CONTINUE ON 9099C***

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Ardalan Gharachorloo
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2025

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-20250409151315

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 PLEASANTON	FACILITY NUMBER: 019201324
	VISIT DATE: 07/02/2025

NARRATIVE

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***CONTINUE FROM 9099***

S1 stated that all guests check in with the front desk and residents are notified immediately. S2 indicated that while staff were made aware of some family conflict, no formal or informal restriction on R1’s visitation was enforced. W1 stated that R1’s daughter was informed of several visitation rules, including providing 24-hour notice, limiting visits to public areas, being accompanied by staff, not bringing a cell phone or guests, and not taking R1 off premises. S3 and S4 stated that on limited occasions, they were asked to be present during visits as a precautionary measure at the POA’s request, but that visits were not prohibited. R2 and R3 both stated they receive visits regularly and had not witnessed staff restricting residents from meeting with family or guests. R1’s care plan and medical assessments did not identify any behavioral, cognitive, or safety concerns that would require limiting or monitoring visits.

W1 also reported that R1 had not seen her daughter for an extended period, and when they did reunite, R1 appeared visibly distressed and expressed that she had been told her daughter no longer wished to see her. W1 stated that during this visit, R1 became emotional, and a staff member approached and asked if she felt safe, to which R1 responded that she did. W1 expressed concern that staff never communicated directly with the daughter about these reported conditions and believes R1 may have received incorrect information that caused confusion. LPA's review of communication logs and admission agreement did not produce evidence that facility staff conveyed inaccurate information to R1 or that they imposed or enforced restrictions in violation of visitation rights.

This agency has investigated the above allegation. We have found that the complaint was 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 allegation is UNSUBSTANTIATED.

Exit interview conducted, a copy of this report provided.

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Ardalan Gharachorloo
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2025

LIC9099 (FAS) - (06/04)

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