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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201317
Report Date: 10/23/2025
Date Signed: 10/23/2025 12:31:03 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
07/14/2025 and conducted by Evaluator Grace Luk
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20250714141403
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: 72DATE:
10/23/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Linda Nguyen, Executive DirectorTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Facility staff did not meet the care needs of the residents.
INVESTIGATION FINDINGS:
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On 10/23/2025 at 10:00AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct complaint investigation and to deliver complaint findings for the allegation above. LPA met with Executive Director, Linda Nguyen and explained the purpose of the visit.

During the investigation, LPA interviewed 3 residents, 5 staff, 2 witnesses, and complainants. LPA reviewed and obtained documents including staff schedule, physician's report, care plan, emergency information, home health notes, incident reports, shower/skin sheets, and staff roster with contact information.

Physician's report dated 4/9/2025 stated that R1 has a history of skin breakdown and home health was ordered. Interview with staff indicated that R1 was repositioned every two hours and R1 receives incontinence care every 2 hours. Interview with witnesses revealed that facility staff are caring, tentative, and W4 observed R1's wounds healed fast.
(Continue on LIC9099C...)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
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-20250714141403
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 PARK AT WALNUT CREEK
FACILITY NUMBER: 079201317
VISIT DATE: 10/23/2025
NARRATIVE
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R1's care plan indicated R1 needed two person during transfers. Witnesses have observed two facility staff when transferring R1. W4 stated facility staff used safe technique during transfer and R1 was well supported. Staff stated there are two person when transferring R1.

Interview with staff revealed there are enough staff to meet the needs of the residents. S1 stated there are 3-4 caregivers for morning and afternoon shifts, and 2 caregivers for night shift.

Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is UNSUBSTANTIATED.

No deficiencies are being cited on this date.

Exit interview conducted. A copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
LIC9099 (FAS) - (06/04)
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