415601177-3-11-2026-14-AS-ACON-DSHP73-20260325110313

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415601177
Report Date: 03/11/2026
Date Signed: 03/11/2026 01:58:24 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/04/2026 and conducted by Evaluator Komal Curley

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20260304103141

FACILITY NAME:	IVY PARK OF BELMONT		FACILITY NUMBER:	415601177
ADMINISTRATOR:	ANNE BUERHAUS		FACILITY TYPE:	740
ADDRESS:	1010 ALAMEDA DE LAS PULGAS		TELEPHONE:	(650) 508-0400
CITY:	BELMONT	STATE: CA	ZIP CODE:	94002
CAPACITY:	117	CENSUS: 79	DATE:	03/11/2026
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Administrator, Anne Buerhaus		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Staff did not ensure the facility telephone is properly operating
Staff provided a resident an inappropriate heating device
Staff did not provide a comfortable temperature for a resident

INVESTIGATION FINDINGS:

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On March 11, 2026, Licensing Program Analyst (LPA) Komal Curley conducted an unannounced 10-day complaint visit. LPA met with Administrator, Anne Buerhaus and explained the purpose of the visit.

Regarding the allegation, staff did not ensure the facility telephone is properly operating, according to the reporting party, on March 2, 2026, he/she received phone calls from the facility's main line, however when he/she tried returning the call, there was no answer. Reporting party indicated that on March 3, 2026, he/she tried calling the facility in the morning again, however there was no answer.

During the investigation, LPA interviewed administrator, staff and tested the facility's main number. LPA confirmed that the facility phone is in good working condition. The administrator indicated that she received at call at 11:37pm on 3/2/26, notifying her that the facility's main phone was not working. The administrator immediately notified the Health Services Director who worked with the Resident Care Coordinator early the next morning to fix the facility phones. (continue to 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Curley
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2026

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 14-AS-20260304103141

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: IVY PARK OF BELMONT	FACILITY NUMBER: 415601177
	VISIT DATE: 03/11/2026

NARRATIVE

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According to the Health Services Director and Resident Care Coordinator, the facility's main phone was not working because on 3/2/26, when the receptionist handed the phone to the med-tech, they did not transfer the phone line properly. In addition, the Resident Care Coordinator confirmed she fixed the phone system on 3/3/26 before 9:30am. Based on documents reviewed, an in-service training was provided on 3/4/26 with med-techs and the receptionists regarding phone hand off.

Regarding the allegation, staff provided a resident an inappropriate heating device, according to the reporting party, the administrator provided Resident 1 (R1) a space heater while the heating in R1's room needed to be fixed, however the space heater did not turn off when tipped over.

During the investigation, LPA interviewed the administrator, maintenance director, and observed R1's room. According to the Maintenance Director and Administrator, R1's responsible party complained about the temperature gage on the thermostat in R1's room and wanted the room temperature to be 80 degrees F. According to the maintenance director, she checked the room temperature several times and notified R1's responsible party that R1's room was reading between regulatory requirements, however R1's responsible party still complained, so the Maintenance Director not only replaced R1's thermostat but also provided R1 with a space heater to put in his/her room. The administrator indicated when she observed the space heater in R1's room, she had to remove it as the facility does not allow heating devices in resident rooms. Furthermore the administrator stated, even after removing the space heater from R1's room and notifying R1's responsible party that it was not allowed, R1's responsible party brought another heating device to the facility to place in R1's room. During the visit, LPA did not observe a space heater in R1's room.

Regarding the allegation, staff did not provide a comfortable temperature for a resident, according to the reporting party, the administrator refused to call an HVAC company to fix the heating in R1's room for over a week.

During the investigation, LPA interviewed the administrator, maintenance director, observed R1's room. According to the administrator, she denied this allegation and indicated that she told R1's responsible party that she wanted to try to fix R1's room temperature in house, if possible, prior to calling HVAC. The administrator and the maintenance director, confirmed that R1's thermostat was in good working condition, however R1's responsible party wanted R1's room to read at 80 degrees F. The maintenance director worked with R1 and R1's responsible party by reading R1's room temperature multiple times and replacing the thermostat. (continue to 9099C)

SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Curley
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 14-AS-20260304103141

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: IVY PARK OF BELMONT	FACILITY NUMBER: 415601177
	VISIT DATE: 03/11/2026

NARRATIVE

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According to the maintenance director and administrator, the temperature readings in R1's room were within regulatory requirements, however R1's responsible party still complained so HVAC was called and they came out to do service in R1's room. During the visit, LPA observed R1's room to be at 76 degrees F.

Based on interviews conducted, documents reviewed, and information collected, the department has determined that although the above allegations may have happened or are valid, there is no preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are UNSUBSTANTIATED.

Report is reviewed with Administrator, Anne Buerhaus and a copy is provided.

SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Komal Curley
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2026

LIC9099 (FAS) - (06/04)

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