565850424-5-12-2025-29-AS-KBUY-DH4TWM-20250528150547

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850424
Report Date: 05/12/2025
Date Signed: 05/12/2025 03:13:14 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
05/09/2025 and conducted by Evaluator Brian Balisi

COMPLAINT CONTROL NUMBER: 29-AS-20250509152429

FACILITY NAME:	IVY PARK AT WOOD RANCH		FACILITY NUMBER:	565850424
ADMINISTRATOR:	LILIT E MNATSAKANYAN		FACILITY TYPE:	740
ADDRESS:	190 TIERRA REJADA WAY		TELEPHONE:	(805) 584-8881
CITY:	SIMI VALLEY	STATE: CA	ZIP CODE:	93065
CAPACITY:	100	CENSUS: 85	DATE:	05/12/2025
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Lilit E Mnatsakanyan		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff does not keep resident’s room free from bed bugs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced complaint visit to investigate the allegation listed above. Upon arrival LPA met with Executive Director Lilit E Mnatsakanyan and explained the reason for the visit.

At approx 10:50 a.m. LPA conducted physical plant, interviewed staff and reviewed and obtained copies of pertinent documentation relevant to the investgiation.

It was reported "Staff does not keep resident’s room free from bed bugs." as it was alleged that the facility has a recurring bed bug problem in multiple rooms, which may be due to staff failing to take appropriate preventative measures. Interviews conducted and a review of facility records, revealed, bed bugs were first identified in Resident #1's (R1) room on 04/09/2025. On 04/11/2025, the pest control company, Ecolab, inspected, treated, and serviced R1’s bedroom.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20250509152429

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 WOOD RANCH	FACILITY NUMBER: 565850424
	VISIT DATE: 05/12/2025

NARRATIVE

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According to the Executive Director, all disposable furniture and affected items were replaced, and R1’s clothing and personal belongings were cleaned and sanitized. Ecolab returned on 04/14/2025, to continue treatment in R1’s room and to inspect the adjacent common areas. No new signs of bed bug activity were observed at that time.

On 04/21/2025, Resident #2 (R2), who resides in the room next to R1, was admitted to the hospital due to concerns related to possible bed bug bites. Hospital discharge documentation indicates that R2 was diagnosed with cellulitis.

On 04/22/2025, Ecolab conducted an inspection and provided pest control services in R2’s room, the room across the hallway, and the nearby common areas. The couches in the memory care common space were also inspected. No new bed bug activity was identified during this inspection. Interviews with facility staff revealed that, since the initial bed bug report, all resident rooms have been inspected each morning for signs of infestation, with no additional activity reported. During the LPA's physical inspection of R1’s room, surrounding rooms, and adjacent areas, no evidence of bed bugs was observed. The facility has demonstrated a proactive approach to pest management and is under a standing contract with Ecolab to conduct monthly inspections and services to help ensure the facility remains free of infestations. 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 keep resident’s room free from bed bugs” is deemed Unsubstantiated at this time.

Exit interview conducted and copy of report issued.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2025

LIC9099 (FAS) - (06/04)

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