306006223-7-29-2026-22-AS-KSGH-DWHV7W-20260731161149

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006223
Report Date: 07/29/2026
Date Signed: 07/29/2026 03:25:41 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/24/2026 and conducted by Evaluator Ruth Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20260424145046

FACILITY NAME:	IVY PARK AT LAGUNA WOODS		FACILITY NUMBER:	306006223
ADMINISTRATOR:	SYED, ZEHRA		FACILITY TYPE:	740
ADDRESS:	24441 CALLE SONORA		TELEPHONE:	(949) 830-8057
CITY:	LAGUNA WOODS	STATE: CA	ZIP CODE:	92637
CAPACITY:	233	CENSUS: 190	DATE:	07/29/2026
		UNANNOUNCED	TIME BEGAN:	07:30 AM
MET WITH:	Zehra Syed		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff stole resident's personal items

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit to the facility to conclude investigation into the above identified complaint allegation. LPA arrived at the facility and was greeted and granted entry. LPA met with Zehra Syed, Executive Director, and explained the purpose of the visit.

Findings are based upon this investigation which included tour of the facility, facility file review, resident file review, police report and interviews conducted.

It is alleged that staff stole resident’s personal items from resident (R1) locked closet in their apartment and from resident (R2) personal items stored in two assigned storage units. Interview with 2 of 2 staff stated that R1 was installed a lock in a closet in their apartment, when lock was installed, staff gave R1
Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2026

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 22-AS-20260424145046

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: IVY PARK AT LAGUNA WOODS	FACILITY NUMBER: 306006223
	VISIT DATE: 07/29/2026

NARRATIVE

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two sets of keys. R1 was the only person with keys to the lock. For R2 when the license and the building were under the previous license, they had issued lockers at no charge to residents, and R2 was one of the residents’ assigned to the lockers. When a resident moves into the community they are given the LIC621 resident personal property and valuables form to fill out along with appendix K theft and loss policy in the admissions agreement. It is the responsibility of the resident to complete the form and submit it to staff and/or when they bring new items it is their responsibility to update the form and inform the staff. On both incidents staff were made aware weeks after the assumed theft and law enforcement was called as per protocol. Since LIC621 was blank for both R1 and R2 staff couldn’t verify what items were stolen or in their respected locked units. LPA toured the physical plant of the facility and observed a locked closet door in between the living room and bedroom in R1’s apartment. It was noted that a new replacement lock had been installed by R1’s family member after the incident. Tour of the storage units LPA observed various storage units with pad locks, zip ties and a simple plastic tie used for a lock. Record review revealed LIC621 for both R1 and R2 were blank and signed by the resident and/or responsible party. Appendix K theft and loss policy from the admissions agreement for both residents are signed by the resident and/or responsible party. Appendix K stated the following: Inventory: Policy: We will maintain a current inventory of all personal property identified by residents on licensing form LIC621. Procedure: Upon admission the resident or responsible part will be provided with a blank LIC621. If the resident or responsible party wishes to inventory personal property, they will complete the inventory in ink and it will be signed and dated by the resident or responsible party, and an Ivy Park representative. A copy will be provided to the resident or responsible party. The facility copy will be maintained in the administrative file. If a resident or responsible party does not complete an inventory or wishes to exclude certain items from the inventory, they will indicate by marking “waived” and sign and date the form. If an inventory is being maintained, as the resident or responsible party brings in new items or removes items, they will be responsible for notifying Ivy Park in writing so that Ivy Park can update their copy if the inventory form.

Based on the information mentioned above, the Department is unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated.

An exit interview was conducted with the Executive Director and a copy of this LIC9099 report was left at facility.

SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2026

LIC9099 (FAS) - (06/04)

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