565850424-6-27-2025-29-AS-KBUY-DK2NSK-20250729104315

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850424
Report Date: 06/27/2025
Date Signed: 06/27/2025 11:43:03 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
06/18/2025 and conducted by Evaluator Brian Balisi

COMPLAINT CONTROL NUMBER: 29-AS-20250618085349

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: 79	DATE:	06/27/2025
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Lilit Mnatsakanyan		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff did not keep the facility free of bedbugs.

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 Mnatsakanyanand explained the reason for the visit.
At approx 09:50 a.m. LPA conducted physical plant, interviewed staff and reviewed and obtained copies of pertinent documentation relevant to the investigation.

It was reported that "Staff did not keep the facility free of bedbugs" as it was alleged that there continues to be a recurring bed bug problem in multiple rooms. On 05/12/2025, LPA conducted an investigation on control # 29-AS-20250509152429, for the allegation "Staff does not keep resident’s room free from bed bugs", it was confirmed that there was an occurrence of bed bugs, however that allegation was found to be Unsubstantiated due to information received stating that the occurrence had been contained to one room and the facility demonstrated a proactive preventative approach by having Ecolab conduct additional visits outside of their normal monthly visits.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2025

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-20250618085349

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: 06/27/2025

NARRATIVE

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Continued from 9099

Since then, interviews conducted and records review revealed Ecolab has conducted additional visits for preventative measures on 05/09/2025, 05/30/2025 where no new bed bug activity was found. On 06/09/2025 during an Ecolab service call, one (1) bed bug was found in room 227. The room was treated on 06/13/2025. Since 06/09/2025, no additional bed bug activity has been reported by staff. During the LPA's physical inspection of rooms, 226, 225, 227, 223, 217, 231, surrounding rooms, and adjacent areas, no evidence of bed bugs was observed. 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 did not keep the facility free of bedbugs” 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: 06/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2025

LIC9099 (FAS) - (06/04)

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