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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201317
Report Date: 04/24/2025
Date Signed: 04/24/2025 05:11:14 PM

Unfounded


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
04/21/2025 and conducted by Evaluator James Sampair
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20250421135946
FACILITY NAME:IVY PARK AT WALNUT CREEKFACILITY NUMBER:
079201317
ADMINISTRATOR:LINDA NGUYENFACILITY TYPE:
740
ADDRESS:2175 YGNACIO VALLEY ROADTELEPHONE:
(925) 932-3500
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94598
CAPACITY:86CENSUS: 68DATE:
04/24/2025
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Executive Director (ED) Linda NguyenTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Staff do not allow resident to participate in decision making regarding their care.
Staff did not provide resident copies of their records.
Staff did not safeguard resident's personal items.
INVESTIGATION FINDINGS:
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On 4/24/2025, at 2:30 PM, Licensing Program Analyst (LPA) James Sampair arrived unannounced at the facility to investigate the allegations above. Upon entry into the facility, the LPA identified himself and stated the purpose of the visit to Executive Director (ED) Linda Nguyen.

The complaint alleges that staff do not allow resident to participate in decision making regarding their care.
The LPA interviewed Witness W1 and the ED. The LPA reviewed records concerning R1's participation in decision making regarding their care. The data collected does not support the allegation.

The complaint alleges that staff did not provide resident copies of their records.
The LPA interviewed Witness W1 and the ED. The ED stated that never once had R1 personally asked for a copy of their records. The only requests came when a friend, Witness W2, made the request or wrote a letter signed by R1. The data collected does not support the allegation.

Continued on LIC 9099-C . . .
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2025
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-20250421135946
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 WALNUT CREEK
FACILITY NUMBER: 079201317
VISIT DATE: 04/24/2025
NARRATIVE
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. . . Continued from LIC 9099

The complaint alleges that staff did not safeguard resident's personal items.
The LPA interviewed Witness W1 and the ED. The ED stated that had R1 never reported anything missing, nor had facility staff taken anything way from R1 unless it was dangerous and not allowed in memory care. The data collected does not support the allegation.

The allegations are false, could not have happened, and/or are without a reasonable basis. Therefore, the allegations are UNFOUNDED.

Exit interview conducted with ED and a copy of this report was provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: James Sampair
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2