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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850299
Report Date: 10/14/2025
Date Signed: 10/14/2025 03:33:56 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/07/2025 and conducted by Evaluator Martha Arroyo
COMPLAINT CONTROL NUMBER: 29-AS-20251007152514
FACILITY NAME:IVY PARK AT SIMI VALLEYFACILITY NUMBER:
565850299
ADMINISTRATOR:BOGOYEVAC, LEAFACILITY TYPE:
740
ADDRESS:5300 E. LOS ANGELES AVE.TELEPHONE:
(805) 583-3500
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93063
CAPACITY:175CENSUS: 133DATE:
10/14/2025
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Dina DavisTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Staff stole resident's personal items.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Martha Arroyo conducted an initial complaint investigation visit for the above allegation. Upon arrival, the LPA met with Regional Operational Specialist (ROS), Dina Davis and explained the reason for the visit. Entrance interview.

During today's visit, between 10:10 a.m. and 1:25 p.m., the LPA interviewed five staff and six residents, conducted a resident file review and obtained copies of pertinent documents.

It was alleged that staff stole resident’s personal items. It was reported that facility staff had been stealing from multiple residents, including pages from a bible and photographs belonging to Resident #1 (R1). Although this was reported to management, no action was taken regarding the matter.

Report Continued on LIC 9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2025
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 29-AS-20251007152514
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: IVY PARK AT SIMI VALLEY
FACILITY NUMBER: 565850299
VISIT DATE: 10/14/2025
NARRATIVE
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Report Continued from LIC 9099...

A review of R1’s personal property inventory list was conducted; however, the list was blank, as R1 chose not to document any personal belongings at the time of admission. Staff interviews revealed that R1 reported certain documents missing from their apartment, including a death certificate. Staff acknowledged R1’s concerns and suggested providing a locked file cabinet for securing personal items. However, R1 declined the facility’s offer. Further staff interviews indicated that staff do not enter resident rooms when the resident is not present. Staff stated that they knock and wait for a response before entering. Additionally, interviews with six out of six residents conducted today revealed no concerns about living in the facility and stated that they had no missing items to report. At this time, there is no evidence indicating that facility staff took any of the allegedly missing items from R1’s room. Based on the information gathered, the Department finds insufficient evidence to support the allegation. Therefore, the allegation is deemed Unsubstantiated at this time.

Exit interview conducted. Report was review and copy issued.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 10/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2