<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850299
Report Date: 10/20/2025
Date Signed: 10/20/2025 02:09:12 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
08/05/2025 and conducted by Evaluator Martha Arroyo
COMPLAINT CONTROL NUMBER: 29-AS-20250805081739
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: 135DATE:
10/20/2025
UNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Dina DavisTIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff do not meet resident’s hygiene needs.
Facility staff did not provide adequate grooming to residents in care.
Facility staff did not ensure resident clothing needs were being met.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA), Martha Arroyo conducted a subsequent complaint visit to the above facility. The purpose of the visit is to deliver findings for the above allegations. The initial complaint visit was conducted on 08/13/2025 by LPA M. Arroyo. On today's visit, LPA Arroyo met with Regional Operational Specialist (ROS), Dina Davis. Entrance interview.

During the initial visit on 08/13/2025, between 10:10 a.m. and 1:15 p.m., LPA Arroyo conducted a brief plant tour, interviewed four staff and Resident #1 (R1) personal companion, conducted a resident file review and obtained copies of pertinent documents relevant to the investigation. A telephonic interview was also conducted with R1’s family member at approximately 2:18 p.m.

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

DATE: 10/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2025
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-20250805081739
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: 10/20/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Report Continued from LIC 9099...
It was alleged that facility staff do not meet resident’s hygiene needs and facility staff did not provide adequate grooming to residents in care. It was reported that R1’s teeth were not being brushed, and old food particles were observed. Additionally, R1 was often seen with uncombed hair. A review of R1’s Physician’s Report dated 01/23/2025 revealed that R1 requires assistance with bathing, dressing/grooming, and toileting needs. Although the report states that R1’s mental condition may include confusion/disorientation, inappropriate behavior, aggressive behavior, and sundowning, R1 is still able to follow instructions and communicate their needs. According to the Resident Assessment dated 07/08/2025, R1 requires hands-on assistance with all grooming and hygiene tasks, assistance with dressing and undressing twice daily, observation and assistance during meals, routine medication management, as well as scheduled toileting and assistance to and from the bathroom. Record review and interviews conducted indicated that R1 is currently receiving hospice care, which provides 2–3 showers per week and ensures that R1’s hygiene needs are met. Staff interviews revealed that caregivers assist residents with grooming and hygiene based on their individualized care plans. Staff also stated that R1’s hair is brushed every morning before breakfast, and teeth are brushed both in the morning and before bedtime. Interviews with R1’s personal companion and family confirmed that hospice services come 2–3 times weekly to provide showers, and facility staff frequently check on R1 throughout the day. Furthermore, R1’s family did not express any concerns regarding R1’s grooming or hygiene needs not being met. Based on the information obtained and reviewed, the Department has insufficient evidence to support the allegations of “facility staff do not meet the resident’s hygiene needs” and “facility staff did not provide adequate grooming to residents in care”. Therefore, these allegations are deemed Unsubstantiated at this time.

It was also alleged that facility staff did not ensure resident clothing needs were being met. It was reported that R1 wore the same clothes for several days in a row. Interviews conducted with staff revealed that all residents’ clothes are changed daily, and laundry is done weekly. Additionally, staff stated that they change R1’s clothes every morning after waking up, before breakfast. Furthermore, an interview with R1’s personal companion confirmed that each morning upon arrival, R1 is observed to be clean and wearing different clothes than the previous day, confirming that facility staff change R1’s clothes at least once daily. Based on the information received, the Department has insufficient evidence to support the allegation of “facility staff did not ensure resident clothing needs were being met”. Therefore, this allegation is deemed Unsubstantiated at this time.

No citations issued at this time. Exit interview conducted. A copy of the report was provided.

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

DATE: 10/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2