565850299-4-26-2024-29-AS-DPEA-D5HRQ8-20240522131304

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850299
Report Date: 04/26/2024
Date Signed: 04/26/2024 01:36:40 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
04/23/2024 and conducted by Evaluator Brian Balisi

COMPLAINT CONTROL NUMBER: 29-AS-20240423112621

FACILITY NAME:	IVY PARK AT SIMI VALLEY		FACILITY NUMBER:	565850299
ADMINISTRATOR:	BOGOYEVAC, LEA		FACILITY TYPE:	740
ADDRESS:	5300 E. LOS ANGELES AVE.		TELEPHONE:	(805) 583-3500
CITY:	SIMI VALLEY	STATE: CA	ZIP CODE:	93063
CAPACITY:	175	CENSUS: 131	DATE:	04/26/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Lea Bogoyevac		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff does not prevent resident's room from having bed bugs.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced complaint visit to investigate the allegations listed above. Upon arrival LPA met with Lea Bogoyevac and explained the reason for the visit.

At approx 9:15 a.m. LPA conducted a physical plant, interviewed staff, residents and reviewed and obtained copies of pertinent documentation relevant to the investigation.

It was reported that staff does not prevent resident's room from having bed bugs as it was alleged, that a residents' room has had ongoing issues with bed bugs for the past (3) months. Interviews conducted and records reviewed reflected that on 03/04/2024, housekeeping staff were conducting a weekly cleaning in Resident #1 (R1)s apartment when they observed evidence of bed bugs. On 03/05/2024, the facilities pest control company Ecolab conducted a visit to treat R1's bedroom for bed bug infestation. On 03/06/2024, a follow up visit was conducted on R1's bedroom to apply additional treatment and inspect surrounding units and common areas.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024

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-20240423112621

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: 04/26/2024

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

Continued from 9099

No pest activity was observed during that visit. On 04/22/2024, housekeeping staff were conducting a weekly cleaning on R1's room and observed evidence of bed bugs. R1 was relocated to a different unit and the room was treated on 04/25/2024. The facility has scheduled another company to conduct a heat treatment on R1's bedroom on 05/01/2024. After the heat treatment the facility will clean and sanitize the room then R1 will be moved back. Records review further revealed, during Ecolab's scheduled monthly visits conducted on 01/18/2024, 02/16/2024, 03/07/2024 and 04/04/2024 their inspection report notated that there were no evidence of pest activity found during those visits. LPA's interview conducted with R1 revealed they have only left the facility with a family member to be taken to medical appointments at a local hospital, but continued to state their family member has not observed any bed bug activity in their own home. Also R1 did not express any potential or immediate concerns that this was an ongoing issue or that the facility staff does not do enough to prevent bed bugs. In addition, LPA's interview conducted with six (6) residents revealed that all (6) have not observed bed bugs or other bug infestations in the facility. Two (2) out of the six (6) residents interviewed were aware that R1's room was being treated for bed bugs and in addition all (6) residents interviewed did not express any potential or immediate concerns that there was an ongoing issue of bed bugs or that the facility staff does not do enough to prevent resident's rooms from having bed bugs. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegation “Staff does not prevent resident's room from having bed bugs ", is deemed Unsubstantiated at this time.

Exit interview conducted and copy of report issued.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2