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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019201329
Report Date: 04/11/2025
Date Signed: 04/11/2025 02:30:52 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
03/13/2025 and conducted by Evaluator Ardalan Gharachorloo
COMPLAINT CONTROL NUMBER: 15-AS-20250313120104
FACILITY NAME:IVY PARK AT OAKLAND HILLSFACILITY NUMBER:
019201329
ADMINISTRATOR:HARRELL, YOLANDAFACILITY TYPE:
740
ADDRESS:11889 SKYLINE BOULEVARDTELEPHONE:
(510) 531-7190
CITY:OAKLANDSTATE: CAZIP CODE:
94619
CAPACITY:100CENSUS: 81DATE:
04/11/2025
UNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Yolanda Harrell, Executive DirectorTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Licensee did not provide resident with a refund
INVESTIGATION FINDINGS:
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On 04/11/2025 at 1:30 PM, Licensing Program Analyst (LPA) Ardalan Gharachorloo arrived unannounced to deliver findings regarding above allegation.LPA met with Executive Director, Yolanda Harrell and explained the purpose of the visit.

Allegation: Licensee did not provide resident with a refund - Unsubstantiated

During the investigation, LPA interviewed the Executive director and Business office director. LPA also obtained the following documents: a copy the R1's admission agreement, R1's payment Ledger/Invoices, and a copy of the 30 day notice. On 03/24/2025, LPA received a ledger from the Executive Director showing that the account has been settled and the late fee has been removed. Executive confirmed that the facility has given R1 the 60% community fee along with removing the late fee.

***CONTINUE ON 9099 C***
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Ardalan Gharachorloo
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 15-AS-20250313120104
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 OAKLAND HILLS
FACILITY NUMBER: 019201329
VISIT DATE: 04/11/2025
NARRATIVE
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*** CONTINUE FROM 9099***

This agency has investigated the complaint regarding allegation above. We have found that the complaint was unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are UNSUBSTANTIATED.

.Exit interview conducted, a copy of this report provided.

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Ardalan Gharachorloo
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2