019201506-6-3-2026-15-AS-BFOG-DVUSQZ-20260710140535

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 019201506
Report Date: 06/03/2026
Date Signed: 06/03/2026 04:29:31 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
05/29/2026 and conducted by Evaluator Kelly Nguyen

COMPLAINT CONTROL NUMBER: 15-AS-20260529091241

FACILITY NAME:	IVY AT BERKELEY, THE		FACILITY NUMBER:	019201506
ADMINISTRATOR:	STICKA, ANGELES		FACILITY TYPE:	740
ADDRESS:	2000 DWIGHT WAY		TELEPHONE:	(510) 900-8959
CITY:	BERKELEY	STATE: CA	ZIP CODE:	94704
CAPACITY:	138	CENSUS: 113	DATE:	06/03/2026
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Angeles Sticka, Excutive Director		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff do not ensure residents are provided a safe and comfortable environment

INVESTIGATION FINDINGS:

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On this day, 6/3/26, at 12:00 noon, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct an initial 10-day investigation of the above allegation and close the complaint. LPA met with Executive Director Angeles Sticka and informed them of the reason for the visit.

During the course of the investigation, LPA obtained copies of the staff schedule and the resident roster. LPA obtained copies of, including but not limited to the following: Fire alarm inspections, including carbon monoxide, email communication between S2 and the company. LPA conducted interviews with Staff 1 (S1), Staff 2 (S2), and Staff 3 (S3). LPA conducted an interview with Resident 1 (R1), Resident 2 (R2), Resident 3 (R3), Resident 4 (R4), Resident 5 (R5), Resident 6 (R6), and Resident 7 (R7). LPA conducted an interview with W1. LPA toured the facility, including but not limited to apartments, bathrooms, kitchen, common area, rooftop, and patios.

Report continued on LIC 9099c…

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2026

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-20260529091241

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: IVY AT BERKELEY, THE	FACILITY NUMBER: 019201506
	VISIT DATE: 06/03/2026

NARRATIVE

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Report continue...

It was alleged that the staff does not ensure residents are provided a safe and comfortable environment. RP stated that the pipe's rooftop power generator faces the facility vent that blew into the resident's room, causing the room to smell like car exhaust. During an interview with S2, an R1 family member mentioned the situation on 4/27/26. S2 follow up with the facility owner on 5/11/26 regrading the concern of R1 family member. S2 contacted the company (Melgar Mechanical) that installed the exhaust pile on 5/14/26. The company came out to inspect the issue on 5/21/26 and returned on 5/29/26 to reposition the pipe. The carbon monoxide check document by Cimino Electric Company and Academy Fire Protection, dated 2/7/25, showed that the carbon monoxide system was in working order. LPA observed that there is no smell in the residents' room and that the exhaust pipe is facing away from the rooftop vent of the facility. R1, R2, R3, R4, R5, R6, R7, and W1 all stated that there is no smell in their room. R1, R2, R3, R4, R5, R6, and R7 stated that they feel safe in the facility and that the facility environment is comfortable.

Based on interviews, record review, and LPA observation, the facility staff is providing a safe and comfortable environment. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred.

No deficiency cited.

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

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2026

LIC9099 (FAS) - (06/04)

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