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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850299
Report Date: 11/21/2024
Date Signed: 11/21/2024 11:39:40 AM

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
11/19/2024 and conducted by Evaluator Martha Arroyo
COMPLAINT CONTROL NUMBER: 29-AS-20241119083142
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: 144DATE:
11/21/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Lea BogoyevacTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Licensee did not provide responsible party with a refund.
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 Executive Director (ED), Lea Bogoyevac. Entrance interview conducted.

During today's visit, the LPA conducted an interview with the ED at 9:20 a.m. and obtained copies of pertinent documents.

It was alleged that licensee did not provide responsible party with a refund. It was reported that the Responsible Party (RP) had toured the facility with the intentions of possibly admitting a family member into the facility. Records review and interview conducted revealed that RP had paid the facility the preadmission fee of $3,500 on 09/26/2024.

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

DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024
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-20241119083142
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: 11/21/2024
NARRATIVE
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Report Continued from LIC 9099...

On 10/04/2024, the RP contacted the facility and informed them that they no longer wished to proceed with the process and had canceled. A review of the Community Fee Receipt indicates that all applicable refunds will be processed within 60 business days. Although the refund check for the RP was not fully approved until six (6) weeks after the RP communicated the cancellation, the RP was issued a refund check for the preadmission fee on 11/20/2024. Furthermore, the RP received the refund of the preadmission fee within the 60 days as initially agreed upon and as stated in the Community Fee Receipt. Based on the information obtained and reviewed, the Department does not have sufficient evidence to support the allegation of “licensee did not provide responsible party with a refund”. 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: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2