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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609362
Report Date: 02/19/2025
Date Signed: 02/19/2025 12:51:17 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/03/2024 and conducted by Evaluator Mariana Agban
COMPLAINT CONTROL NUMBER: 31-AS-20241003120407
FACILITY NAME:IVY PARK AT BURBANKFACILITY NUMBER:
197609362
ADMINISTRATOR:DAWN SMITHFACILITY TYPE:
740
ADDRESS:2721 WILLOW STREETTELEPHONE:
(818) 954-9500
CITY:BURBANKSTATE: CAZIP CODE:
91505
CAPACITY:130CENSUS: 88DATE:
02/19/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Brittney Buchannan- Administrator TIME COMPLETED:
01:35 PM
ALLEGATION(S):
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Staff had an inappropriate sexual interaction with resident in care
INVESTIGATION FINDINGS:
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On 02/19/25, Licensing Program Analysts (LPAs) Mariana Agban, Nadia Shahbazian, Angela Panushkina, Lesile Ngo-Castaneda, and Licensing Program Manager (LPM) Eva Miller conducted an unannounced visit to the facility to deliver the finding on the above allegation. LPAs and LPM met with the Executive Director Brittney Buchannan and explained the purpose of the visit.
On October 10, 2024, the Woodland Hills South Adult and Senior Care office received a complaint alleging that staff had an inappropriate sexual interaction with resident in care. The investigation was conducted by Investigator Dennis Douglas from the Community Care Licensing Division (CCLD) Investigations Branch. The following was determined:
Allegation: Staff had an inappropriate sexual interaction with resident in care. During the investigation, the Department conducted interviews with facility staff, the Burbank Police Department, the detective assigned to the case, and residents at the facility. Copies of Resident #1 (R1), Resident #2 (R2), and Staff #1 (S1) files, the incident report (SIR), the IB Investigation Report, and police investigative reports were obtained and reviewed. (Continue on 9099C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
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 3
Control Number 31-AS-20241003120407
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: IVY PARK AT BURBANK
FACILITY NUMBER: 197609362
VISIT DATE: 02/19/2025
NARRATIVE
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The investigation revealed that on 09/13/2024, Staff #1 (S1) was observed kissing R1 on the lips by R2. S1 initially denied the allegation during the facility's internal investigation but later acknowledged kissing R1 on the forehead during questioning by the Burbank Police Department detective. Throughout the investigation, interviews with facility staff indicated that S1 exhibited unusual behaviors with residents, such as caressing their hands and feet. Ultimately, S1 was arrested by the Burbank Police Department and terminated on 09/23/24. It was determined that S1 sexually assaulted R1; therefore, based on the conducted interviews and the review of the investigation reports, the allegation is deemed substantiated.

An immediate civil penalty of $500 will be assessed today for sexual assault. The Executive Director was informed that additional civil penalties may be applied based on Health and Safety Code 1548.

Deficiency cited (refer to LIC9099-D). Exit interview conducted. Appeal rights were provided, and a copy of this report was issued to the Executive Director.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 31-AS-20241003120407
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: IVY PARK AT BURBANK
FACILITY NUMBER: 197609362
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/19/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
02/19/2025
Section Cited
CCR
87468(a)(1)
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 (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by:
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S1 was terminated. An immediate civil penalty in the amount of $500 is issued.
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Based on the investigation conducted by the Investigative Branch, substantiating sexual assault perpetrated by staff #1 (S1) on Resident #1 (R1) which posed an immediate health and safety risk or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Mariana Agban
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3