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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850299
Report Date: 05/08/2025
Date Signed: 05/08/2025 02:48:57 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
11/05/2024 and conducted by Evaluator Martha Arroyo
COMPLAINT CONTROL NUMBER: 29-AS-20241105134333
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: 142DATE:
05/08/2025
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Lea BogoyevacTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff are providing medications to resident without physician's orders.
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 allegation. Upon arrival, LPA Arroyo met with Executive Director (ED), Lea Bogoyevac. Entrance interview.

The initial visit and subsequent visit were conducted by LPA Arroyo on 11/14/2024 and 04/22/2025. On 11/14/2024, LPA Arroyo conducted interviews with the ED and two staff between 2:15PM and 3:40PM, conducted a file review starting at 2:30PM and obtained copies of pertinent documents. On 04/22/2025, LPA Arroyo conducted interviews with three staff and eight residents, conducted a medication review, and conducted a file review and obtained copies of pertinent documents between 1:45PM and 3:35PM. On 11/15/2024, LPA Arroyo conducted a collateral visit at a day program and interviewed one staff starting at 9:25AM and conducted a file review at approximately 9:40AM and obtained copies of pertinent documents. Hospital records were also obtained and reviewed.
Report Continued on LIC 9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Martha Arroyo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025
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-20241105134333
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: 05/08/2025
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 are providing medication to resident without physician’s order. It was reported that Resident #1 (R1) had been given prescription medications at the facility against the orders of R1’s physician and without a valid prescription. Additionally,it was reported that facility staff administered medication to R1 without a doctor’s order in an attempt to chemically sedate the resident. These medications were said to cause R1 mental distress and behavioral changes.

Records reviewed and interviews conducted revealed that R1 had become more disruptive than usual and harder to redirect while attending the day program around April–May 2024. According R1’s physician's report dated 08/11/2022, R1’s primary diagnosis were autism spectrum disorder and mild cognitive impairment. The report also indicated that R1 experienced confusion, disorientation, and exhibited inappropriate and aggressive behaviors. However, the resident did not have any medications prescribed by their physician. Staff interviews revealed that R1’s family was informed of the resident’s behavioral changes, which included signs of sundowning in the afternoons and what appeared to be panic attacks. Staff stated that both R1’s family and paramedics were contacted during these episodes; however, either R1 or R1’s family declined hospital transfer. As an alternative, staff suggested hiring a personal companion, which the family agreed to try in hopes of alleviating R1’s symptoms. Staff interviews further revealed that all medications are administered strictly according to doctors’ orders and staff denied giving medication to any resident without a valid prescription on file. On 11/09/2024, during a behavioral episode, 911 was called and R1 was transported to the hospital for evaluation. While hospitalized, R1 underwent testing for the presence of any drugs or substances in their system; all test results came back negative. Furthermore, interviews with other residents indicated that they were receiving their prescribed medications without issue and reported no concerns about living in the facility.

Based on the information obtained during the course of the investigation, the Department has insufficient evidence to support the allegation of “facility staff are providing medications to resident without physician’s orders”. Therefore, this allegation is deemed Unsubstantiated at this time.

Exit interview conducted. No citations issued. A copy of the report was issued.

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

DATE: 05/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2