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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019201329
Report Date: 06/19/2025
Date Signed: 06/19/2025 03:04:41 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
06/17/2025 and conducted by Evaluator Ardalan Gharachorloo
COMPLAINT CONTROL NUMBER: 15-AS-20250617132913
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: 78DATE:
06/19/2025
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Yolanda Harrell, AdministratorTIME COMPLETED:
03:40 PM
ALLEGATION(S):
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Facility staff did not ensure resident was broguht down for meal service.
INVESTIGATION FINDINGS:
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On 06/19/2025 at 1:45 PM, Licensing Program Analyst (LPA) Ardalan Gharachorloo arrived unannounced to conduct an initial 10-day complaint investigation and deliver findings in regard to the allegation above. LPA met Yolanda Harrell, Administrator, and explained the purpose of the visit.

During the course of the investigation, LPAs interviewed S1, and W1. LPA reviewed R1’s needs and services plan and W1's email correspondence with the facility.

Allegation: Facility staff did not ensure resident was brought down for meal service : Unsubstantiated

LPA interviewed S1 regarding the complaint received from W1 on 06/17/2025. W1 had initially reported that R1 was not brought to the dining room for breakfast and was found in bed without pants when the private caregiver arrived around 11:00 AM.

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

DATE: 06/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025
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-20250617132913
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: 06/19/2025
NARRATIVE
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***CONTINUE FROM 9099***

W1 also mentioned that staff had confirmed R1 missed breakfast. This concern was originally sent via email to facility staff, and W1 expressed frustration over lack of timely communication regarding care issues.

However, later the same day, W1 sent a follow up email stating that after receiving clarification from staff, she realized she had misread the caregiver’s text and acknowledged that S2 in fact provided care. W1 sent an email to S1 on 06/17/2025 stating “ I will withdraw my complaint to the DSS regarding today” and stated " she had no reason to doubt the staff member involved".

This agency has investigated the complaint alleging Facility staff did not ensure resident was brought down for meal service. 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: 06/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2