Inspection Reports for
Ivy Park at Simi Valley
5300 E Los Angeles Ave, Simi Valley, CA 93063, United States, CA, 93063
Back to Facility ProfileDeficiencies (last 4 years)
Deficiencies (over 4 years)
2.3 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
43% better than California average
California average: 4 deficiencies/yearDeficiencies per year
8
6
4
2
0
Census
Latest occupancy rate
74% occupied
Based on a January 2026 inspection.
Occupancy over time
Inspection Report
Complaint Investigation
Census: 130
Capacity: 175
Deficiencies: 0
Date: Jan 16, 2026
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations that staff did not communicate with the responsible party regarding resident's care, did not allow a resident to have visitors, and did not report an incident to the responsible party.
Complaint Details
The complaint involved three allegations: 1) staff did not communicate with the responsible party regarding resident's care, 2) staff did not allow a resident to have visitors, and 3) staff did not report an incident to the responsible party. All allegations were investigated and found unsubstantiated.
Findings
The investigation included interviews with staff and residents, and a review of records. All three allegations were deemed unsubstantiated due to insufficient evidence to confirm whether violations occurred. Residents expressed no concerns regarding visitors, and staff communicated incidents to responsible parties as required.
Report Facts
Capacity: 175
Census: 130
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Martha Arroyo | Licensing Program Analyst | Conducted the complaint investigation visit |
| Galina Tovmasian | Executive Director | Met with the Licensing Program Analyst during the investigation |
| Lea Bogoyevac | Administrator | Facility administrator named in the report header |
Inspection Report
Complaint Investigation
Census: 135
Capacity: 175
Deficiencies: 0
Date: Oct 20, 2025
Visit Reason
The visit was conducted as a complaint investigation following a complaint received on 2025-06-10 alleging that the facility did not meet the needs of Resident #1 by failing to provide proper care to the resident's toe.
Complaint Details
The complaint alleged neglect and lack of care for Resident #1, including failure to provide timely medical attention resulting in sepsis and death. The Department previously investigated a related complaint from 2024 and found it unsubstantiated. The current investigation also found insufficient evidence to substantiate the allegations.
Findings
The investigation found insufficient evidence to support the allegation that the facility failed to meet the needs of Resident #1. The complaint was deemed unsubstantiated based on interviews, medical records, and other documentation indicating adequate care was provided.
Report Facts
Capacity: 175
Census: 135
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Martha Arroyo | Licensing Program Analyst | Conducted the complaint investigation visit and interviews |
| Dina Davis | Regional Operational Specialist | Met with the Licensing Program Analyst during the inspection visit |
| Desaree Perera | Supervisor | Supervisor overseeing the investigation |
Inspection Report
Complaint Investigation
Census: 135
Capacity: 175
Deficiencies: 0
Date: Oct 20, 2025
Visit Reason
The visit was an unannounced complaint investigation conducted to address allegations that facility staff did not meet residents' hygiene needs, did not provide adequate grooming, and did not ensure resident clothing needs were met.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included failure to meet resident hygiene needs, inadequate grooming, and failure to ensure resident clothing needs. Evidence from staff interviews, resident assessments, hospice care, and family statements did not support these allegations.
Findings
The investigation found insufficient evidence to support the allegations regarding hygiene, grooming, and clothing needs. Resident #1 was receiving hospice care with assistance for hygiene, grooming, and clothing needs, and family and staff interviews confirmed care was adequate. Therefore, all allegations were deemed unsubstantiated and no citations were issued.
Report Facts
Capacity: 175
Census: 135
Complaint Control Number: 29-AS-20250805081739
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Martha Arroyo | Licensing Program Analyst | Conducted the complaint investigation and subsequent visit |
| Dina Davis | Regional Operational Specialist | Met with the Licensing Program Analyst during the visit |
| Lea Bogoyevac | Administrator | Facility administrator named in the report |
Inspection Report
Complaint Investigation
Census: 133
Capacity: 175
Deficiencies: 0
Date: Oct 14, 2025
Visit Reason
An unannounced complaint investigation visit was conducted in response to an allegation that staff stole residents' personal items.
Complaint Details
The allegation was that facility staff stole personal items from multiple residents, including pages from a bible and photographs belonging to Resident #1. After investigation, including interviews and file reviews, there was insufficient evidence to substantiate the claim.
Findings
The investigation included interviews with staff and residents, a review of resident files, and examination of personal property inventories. No evidence was found to support the allegation, and the complaint was deemed unsubstantiated.
Report Facts
Capacity: 175
Census: 133
Staff interviewed: 5
Residents interviewed: 6
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Martha Arroyo | Licensing Program Analyst | Conducted the complaint investigation visit |
| Dina Davis | Regional Operational Specialist | Met with the Licensing Program Analyst during the investigation |
| Lea Bogoyevac | Administrator | Facility administrator named in the report |
Inspection Report
Complaint Investigation
Census: 137
Capacity: 175
Deficiencies: 0
Date: Aug 13, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation that staff did not ensure that resident's grooming needs were met.
Complaint Details
The complaint alleged that staff did not ensure residents' grooming needs were met, including concerns about a beautician sending residents back with wet hair and accepting cash payments. The allegation was found unsubstantiated after interviews and record reviews.
Findings
The investigation revealed that beauty salon services were provided by independent contractors, not facility employees, and no residents or family members reported concerns about staff care. There was insufficient evidence to substantiate the allegation, which was deemed unsubstantiated.
Report Facts
Facility capacity: 175
Census: 137
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lea Bogoyevac | Executive Director | Met with Licensing Program Analyst during the investigation |
| Martha Arroyo | Licensing Program Analyst | Conducted the complaint investigation visit |
| Desaree Perera | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 132
Capacity: 175
Deficiencies: 0
Date: Jun 5, 2025
Visit Reason
The inspection visit was conducted as a complaint investigation following allegations received on 10/30/2024 regarding neglect, lack of care and supervision, and failure to meet residents' incontinence and dietary needs.
Complaint Details
The complaint was unsubstantiated. Allegations included unexplained bruises on a resident, failure to meet incontinence needs, and failure to meet dietary needs. The investigation included interviews with staff, residents, and the resident's power of attorney, as well as review of medical and care records. No evidence supported the allegations.
Findings
The investigation found insufficient evidence to substantiate the allegations of neglect, failure to meet incontinence needs, and failure to meet dietary needs. Interviews, record reviews, and observations indicated that resident care was appropriate and no intentional harm or neglect was identified.
Report Facts
Capacity: 175
Census: 132
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lea Bogoyevac | Executive Director | Met with Licensing Program Analyst during investigation |
| Martha Arroyo | Licensing Program Analyst | Conducted complaint investigation visit and authored report |
| Desaree Perera | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Census: 160
Capacity: 175
Deficiencies: 1
Date: May 19, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations including staff not providing timely medical attention to a resident, resident sustaining pressure injuries, lack of supervision resulting in a fall, staff not assisting with daily needs, and staff not checking resident's blood pressure as required.
Complaint Details
The complaint investigation was substantiated for the allegation that staff did not provide medical attention to a resident in a timely manner, specifically failing to replace a Fentanyl pain patch on schedule. Other allegations including pressure injury due to neglect, lack of supervision causing a fall, failure to assist with daily needs, and failure to check blood pressure were unsubstantiated.
Findings
The investigation substantiated the allegation that staff did not provide timely medical attention related to a pain patch replacement for Resident 2. Other allegations including pressure injuries due to neglect, lack of supervision causing a fall, failure to assist with daily needs, and failure to check blood pressure were deemed unsubstantiated due to insufficient evidence.
Deficiencies (1)
The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by the facility staff not providing confirmation that Resident 2’s pain patch was replaced as prescribed, posing an immediate health and safety risk.
Report Facts
Capacity: 175
Census: 160
Deficiency due date: May 20, 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Brian Balisi | Licensing Program Analyst | Conducted the complaint investigation and subsequent visits |
| Lea Bogoyevac | Executive Director | Met with Licensing Program Analyst during the investigation |
| Desaree Perera | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
Inspection Report
Complaint Investigation
Census: 135
Capacity: 175
Deficiencies: 0
Date: May 10, 2025
Visit Reason
The visit was an unannounced complaint investigation conducted in response to allegations received on 2024-12-03 regarding chemical restraint and medication administration without a doctor's prescription at the facility.
Complaint Details
The complaint alleged that staff chemically restrained a resident for financial gain and administered medication without a doctor's prescription. The investigation included interviews, record reviews, and facility tours. The allegations were found unsubstantiated.
Findings
The investigation found no discrepancies in medication records and no evidence supporting the allegations. Staff and hospice records confirmed proper care and medication administration. Random resident interviews reported satisfaction with care. The allegations were deemed unsubstantiated due to insufficient evidence.
Report Facts
Capacity: 175
Census: 135
Residents interviewed: 8
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Zabel Chochian | Licensing Program Analyst | Conducted the complaint investigation and interviews |
| Lea Bogoyevac | Executive Director | Facility administrator involved in investigation discussions |
| Joseph Bautista | Health Services Director | Met with Licensing Program Analyst during investigation |
| Amy Curtis | Marketing Director | Met with Licensing Program Analyst during investigation |
| Desaree Perera | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Census: 142
Capacity: 175
Deficiencies: 0
Date: May 8, 2025
Visit Reason
The visit was conducted to investigate a complaint alleging that facility staff were providing medications to a resident without physician's orders.
Complaint Details
The complaint alleged that Resident #1 was given prescription medications without a valid physician's order, including attempts to chemically sedate the resident causing mental distress and behavioral changes. The investigation included interviews, file reviews, medication reviews, and hospital testing. The allegation was found unsubstantiated.
Findings
The investigation found insufficient evidence to support the allegation that staff administered medication without a valid prescription. Interviews, record reviews, and hospital testing confirmed no medications were given without physician orders. The allegation was deemed unsubstantiated.
Report Facts
Facility capacity: 175
Census: 142
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Martha Arroyo | Licensing Program Analyst | Conducted the complaint investigation and visits |
| Lea Bogoyevac | Executive Director | Met with Licensing Program Analyst during the investigation |
| Desaree Perera | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 142
Capacity: 175
Deficiencies: 1
Date: May 8, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by multiple allegations received on 2024-08-13 regarding hygiene, medication administration, staff responsiveness, blood pressure monitoring, incontinence care, and staff behavior at the facility.
Complaint Details
The complaint investigation was triggered by allegations including failure to meet hygiene needs, failure to ensure clean clothing, failure to dispense medications as prescribed, failure to respond to resident calls timely, failure to check blood pressure as required, failure to meet incontinence care needs, and staff yelling in the presence of residents. All allegations except the last were found unsubstantiated. The yelling allegation was substantiated.
Findings
The investigation found insufficient evidence to substantiate allegations related to hygiene needs, clean clothing, medication administration, timely response to calls, blood pressure monitoring, and incontinence care. However, the allegation that facility staff yelled in the presence of residents was substantiated, resulting in a cited deficiency related to residents' personal rights.
Deficiencies (1)
Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by facility staff yelling in the presence of residents.
Report Facts
Capacity: 175
Census: 142
Deficiency Type B: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Martha Arroyo | Licensing Program Analyst | Conducted the complaint investigation and delivered findings |
| Lea Bogoyevac | Executive Director | Met with Licensing Program Analyst during investigation and mentioned in findings |
Inspection Report
Annual Inspection
Census: 138
Capacity: 175
Deficiencies: 0
Date: Apr 10, 2025
Visit Reason
An unannounced annual inspection was conducted to evaluate compliance with licensing requirements and ensure the facility meets health and safety standards.
Findings
The facility was found to be in compliance with Title 22 regulations, with clean and appropriately furnished resident rooms, sufficient food supplies, well-maintained common and outdoor areas, and proper medication management. No citations were issued during the inspection.
Report Facts
Resident rooms observed: 11
Resident records reviewed: 10
Staff records reviewed: 10
Staff interviewed: 6
Residents interviewed: 5
Fire extinguisher last serviced: Nov 6, 2024
Last fire safety inspection date: Apr 23, 2024
Last emergency disaster drill date: Feb 5, 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lea Bogoyevac | Executive Director | Met with during inspection and involved in entrance interview and facility tour. |
| Vana Dunn | Memory Care Director | Met with upon arrival and explained reason for visit. |
| Martha Arroyo | Licensing Program Analyst | Conducted the inspection. |
| Brian Balisi | Licensing Program Analyst | Conducted the inspection. |
Inspection Report
Annual Inspection
Census: 138
Capacity: 175
Deficiencies: 0
Date: Apr 10, 2025
Visit Reason
An unannounced annual inspection was conducted to evaluate compliance with Title 22 regulations and ensure the facility meets health and safety standards.
Findings
The facility was found to be in compliance with applicable regulations, with clean and appropriately furnished resident rooms, well-maintained common and outdoor areas, proper medication storage and administration, and adequate emergency preparedness. No citations or deficiencies were issued during this inspection.
Report Facts
Resident rooms inspected: 11
Resident records reviewed: 10
Staff records reviewed: 10
Staff interviewed: 6
Residents interviewed: 5
Fire extinguisher last serviced: Nov 6, 2024
Last fire safety inspection date: Apr 23, 2024
Last disaster drill date: Feb 5, 2025
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lea Bogoyevac | Executive Director | Met with during inspection and involved in facility tour |
| Vana Dunn | Memory Care Director | Met with upon arrival and involved in inspection |
| Martha Arroyo | Licensing Program Analyst | Conducted the inspection |
| Brian Balisi | Licensing Program Analyst | Conducted the inspection |
Inspection Report
Complaint Investigation
Census: 140
Capacity: 175
Deficiencies: 0
Date: Mar 20, 2025
Visit Reason
The visit was conducted to investigate complaints alleging that staff were not practicing proper hand hygiene and that staff did not ensure the kitchen was clean.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included improper hand hygiene and unclean kitchen. After interviews, observations, and record reviews, the Department found insufficient evidence to support these allegations.
Findings
The investigation found insufficient evidence to support the allegations. Staff were observed and interviewed, and records reviewed showed compliance with hand hygiene protocols and kitchen cleanliness. Both allegations were deemed unsubstantiated.
Report Facts
Capacity: 175
Census: 140
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lea Bogoyevac | Executive Director | Met during the inspection and involved in entrance interview |
| Martha Arroyo | Licensing Program Analyst | Conducted the complaint investigation visit |
| Desaree Perera | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 142
Capacity: 175
Deficiencies: 0
Date: Jan 28, 2025
Visit Reason
An unannounced complaint investigation visit was conducted in response to an allegation that staff handled a resident in a rough manner resulting in injury.
Complaint Details
The complaint alleged that staff handled a resident roughly causing injury, including scratching the resident during bathing. The investigation included interviews with staff and residents, a review of pertinent documents, and assessment of the resident. The allegation was found unsubstantiated due to lack of evidence.
Findings
The investigation found no evidence to support the allegation. Interviews with staff and residents indicated no aggressive or rough behavior by staff, and no physical injuries were observed on the resident. The allegation was deemed unsubstantiated.
Report Facts
Capacity: 175
Census: 142
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lea Bogoyevac | Executive Director | Met with during the investigation visit |
| Martha Arroyo | Licensing Program Analyst | Conducted the complaint investigation |
| Desaree Perera | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 142
Capacity: 175
Deficiencies: 0
Date: Dec 20, 2024
Visit Reason
An unannounced complaint investigation was conducted in response to an allegation that staff did not ensure the facility was free from pests.
Complaint Details
The complaint alleged that staff did not ensure the facility was free from pests, specifically that a resident was being bitten by earwigs. The investigation included interviews, observations, and record reviews. The allegation was found unsubstantiated due to insufficient evidence.
Findings
The investigation found no evidence of pests in the facility despite reports from a resident about earwigs. Staff inspections and monthly pest control services were documented, and other residents denied pest issues. The allegation was deemed unsubstantiated.
Report Facts
Capacity: 175
Census: 142
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lea Bogoyevac | Executive Director | Met with Licensing Program Analyst during the investigation |
| Martha Arroyo | Licensing Program Analyst | Conducted the complaint investigation visit |
| Desaree Perera | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 144
Capacity: 175
Deficiencies: 0
Date: Nov 21, 2024
Visit Reason
The visit was an unannounced complaint investigation regarding an allegation that the licensee did not provide the responsible party with a refund.
Complaint Details
The complaint alleged that the licensee did not provide the responsible party with a refund. The allegation was found unsubstantiated after review of documents and interviews.
Findings
The investigation found that the responsible party had paid a preadmission fee of $3,500 but later canceled the admission process. The facility issued a refund check within the agreed 60 business days timeframe. The allegation was deemed unsubstantiated due to insufficient evidence.
Report Facts
Preadmission fee: 3500
Refund processing time: 60
Census: 144
Total capacity: 175
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Martha Arroyo | Licensing Program Analyst | Conducted the complaint investigation visit and interviews |
| Lea Bogoyevac | Executive Director | Met with Licensing Program Analyst during investigation |
| Desaree Perera | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Census: 146
Capacity: 175
Deficiencies: 0
Date: Oct 22, 2024
Visit Reason
The visit was an unannounced complaint investigation triggered by an allegation that staff handled a resident in a rough manner.
Complaint Details
The complaint alleged that two caregivers were rough with Resident #1, resulting in bruises on the resident's arms. The resident has osteoarthritis and mild cognitive impairment. Staff reported the resident has a personal companion 24 hours a day due to prior allegations. Observations and interviews did not find bruising or consistent statements to support the allegation. The complaint was deemed unsubstantiated.
Findings
The investigation found insufficient evidence to substantiate the allegation of rough handling of the resident. Interviews, record reviews, and observations did not corroborate the claim, and no citations were issued.
Report Facts
Capacity: 175
Census: 146
Complaint Control Number: 29-AS-20241014190246
Dates referenced: Complaint received 2024-10-14, initial visit 2024-10-17, report date 2024-10-22
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Martha Arroyo | Licensing Program Analyst | Conducted the complaint investigation and visits |
| Lea Bogoyevac | Executive Director | Met with during the investigation |
| Desaree Perera | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Complaint Investigation
Census: 145
Capacity: 175
Deficiencies: 0
Date: Sep 30, 2024
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations of neglect and lack of care and supervision, specifically that a resident died as a result of facility neglect and that staff did not provide timely medical attention resulting in sepsis.
Complaint Details
The complaint involved two allegations: 1) Facility Resident #1 died due to facility neglect; 2) Staff did not provide medical attention in a timely manner resulting in sepsis. The allegations were investigated through interviews, medical record reviews, and facility logbook examination. The findings were unsubstantiated based on evidence from the coroner, physicians, home health nurses, and facility staff.
Findings
The investigation found insufficient evidence to substantiate the allegations of neglect or failure to provide timely medical attention. Medical records, interviews, and the coroner's report indicated no trauma or neglect associated with the resident's death, and the facility was deemed to have provided adequate care.
Report Facts
Facility capacity: 175
Census: 145
Complaint received date: Apr 19, 2024
Resident death date: Jan 23, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lea Bogoyevac | Executive Director | Met with Licensing Program Analyst during investigation |
| Brian Balisi | Licensing Program Analyst | Conducted complaint investigation visit and authored report |
| Dennis Seng | Investigator | Assigned to complaint investigation and conducted interviews |
Inspection Report
Complaint Investigation
Census: 145
Capacity: 175
Deficiencies: 1
Date: Sep 24, 2024
Visit Reason
The visit was conducted as a Case Management - Deficiencies visit in conjunction with a complaint investigation to issue a citation for a deficiency observed during the initial complaint investigation.
Complaint Details
The visit was triggered by Complaint Control # 29-AS-20231208092110. The deficiency cited was related to the complaint and had already been cited under this complaint control number.
Findings
The investigation revealed a discrepancy between staff statements and a physician's report regarding Resident #1's ability to leave the facility unassisted and manage activities of daily living. A deficiency was cited related to this issue, which had already been cited under the initial complaint control number.
Deficiencies (1)
Deficiency related to Resident #1's care needs and ability to leave the facility unassisted, contrary to staff statements.
Report Facts
Capacity: 175
Census: 145
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Martha Arroyo | Licensing Program Analyst | Conducted the Case Management - Deficiencies visit |
| Lea Bogoyevac | Administrator/Director | Met with during the inspection |
Inspection Report
Complaint Investigation
Census: 145
Capacity: 175
Deficiencies: 1
Date: Sep 24, 2024
Visit Reason
The visit was an unannounced complaint investigation conducted in response to allegations received on 2023-11-03 regarding staff not meeting residents' toileting needs, not ensuring adequate feeding, and mismanaging resident medication.
Complaint Details
The complaint investigation was triggered by allegations that staff did not meet residents' toileting needs, did not ensure adequate feeding, and mismanaged resident medication. The toileting and feeding allegations were unsubstantiated, while the medication mismanagement allegation was substantiated.
Findings
The investigation found the allegations regarding toileting needs and adequate feeding to be unsubstantiated due to insufficient evidence. However, the allegation of staff mismanaging resident medication was substantiated, with findings that medication documentation was not properly maintained and medication lists were not updated before being provided to medical providers.
Deficiencies (1)
The licensee did not comply with the requirement to properly document medications on the Centrally Stored Medication and Destruction Record (CSMDR), posing an immediate health and safety concern.
Report Facts
Capacity: 175
Census: 145
Medication review sample size: 6
Medication review sample size: 3
Staff interviews: 5
Staff interviews: 2
Resident interviews: 9
Plan of Correction due date: Sep 30, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lea Bogoyevac | Executive Director | Met with during the investigation and mentioned in findings |
| Martha Arroyo | Licensing Program Analyst | Conducted the complaint investigation and multiple visits |
| Desaree Perera | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 145
Capacity: 175
Deficiencies: 1
Date: Sep 24, 2024
Visit Reason
The visit was conducted as a Case Management - Deficiencies inspection in conjunction with a complaint investigation (Complaint Control # 29-AS-20231208092110) to issue a citation for a deficiency observed during the initial complaint investigation.
Complaint Details
The visit was triggered by a complaint (Complaint Control # 29-AS-20231208092110). The deficiency cited was related to the complaint and had already been cited under the complaint control number.
Findings
Interviews and record reviews revealed conflicting information regarding Resident #1's ability to leave the facility unassisted and manage activities of daily living. The physician's report indicated the resident required assistance with ADLs and could not leave unassisted, leading to a cited deficiency under California regulations.
Deficiencies (1)
Violation related to Resident #1's assistance needs and unassisted leaving of the facility, contrary to physician's report.
Report Facts
Facility capacity: 175
Resident census: 145
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lea Bogoyevac | Administrator/Director | Met with during the inspection |
| Martha Arroyo | Licensing Program Analyst | Conducted the inspection visit |
| Desaree Perera | Supervisor | Supervisor named in the report |
Inspection Report
Complaint Investigation
Census: 145
Capacity: 175
Deficiencies: 2
Date: Sep 24, 2024
Visit Reason
The visit was an unannounced complaint investigation triggered by allegations including staff not preventing a COVID outbreak and neglecting resident care, specifically failure to check on a resident resulting in injuries and malfunctioning call button.
Complaint Details
The complaint investigation was initiated due to allegations that staff did not prevent a COVID outbreak and neglected resident care. The COVID outbreak allegation was unsubstantiated. The allegations that staff neglected to check on a resident resulting in injuries and that the resident's call button was not working were substantiated.
Findings
The allegation that staff did not prevent the COVID outbreak was unsubstantiated as the facility took appropriate precautions and reported cases properly. However, allegations that staff neglected to check on a resident resulting in multiple injuries and that the resident's call button was not working were substantiated. Deficiencies related to care and supervision and personal rights were cited.
Deficiencies (2)
Staff did not check on Resident #1 in a timely manner resulting in multiple injuries, posing an immediate health and safety risk.
Facility staff did not ensure that Resident #1's call pendant was functioning properly, posing a potential risk to residents.
Report Facts
Residents tested positive for COVID: 40
Plan of Correction Due Date: 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lea Bogoyevac | Executive Director | Met with Licensing Program Analyst during investigation visits |
| Martha Arroyo | Licensing Program Analyst | Conducted complaint investigation visits and authored report |
| Desaree Perera | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
Inspection Report
Complaint Investigation
Census: 131
Capacity: 175
Deficiencies: 0
Date: Apr 26, 2024
Visit Reason
An unannounced complaint investigation was conducted to investigate allegations that staff did not prevent a resident's room from having bed bugs.
Complaint Details
The complaint alleged that staff did not prevent a resident's room from having bed bugs. The investigation included interviews, physical plant inspection, and review of pest control records. The allegation was found unsubstantiated as there was no preponderance of evidence to prove the violation.
Findings
The investigation found evidence of bed bugs in a resident's room with multiple treatments conducted, but interviews with residents and staff, as well as pest control reports, showed no ongoing infestation or failure by staff to prevent bed bugs. The allegation was deemed unsubstantiated due to insufficient evidence.
Report Facts
Capacity: 175
Census: 131
Dates of pest control visits: Monthly visits on 01/18/2024, 02/16/2024, 03/07/2024, 04/04/2024 with no evidence of pest activity
Bed bug treatment dates: Treatment visits on 03/05/2024, 03/06/2024, 04/25/2024 and scheduled heat treatment on 05/01/2024
Residents interviewed: 6
Resident relocation: 1
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Brian Balisi | Licensing Program Analyst | Conducted the complaint investigation and inspection |
| Lea Bogoyevac | Administrator | Met with Licensing Program Analyst during the investigation |
| Desaree Perera | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Annual Inspection
Census: 131
Capacity: 175
Deficiencies: 1
Date: Apr 15, 2024
Visit Reason
The inspection was an unannounced required annual visit to ensure the facility's compliance with Title 22 Regulations and to check for health and safety hazards.
Findings
The facility was found to be generally in compliance with regulations, with clean and properly supplied resident bedrooms and bathrooms, functional safety features, adequate emergency preparedness, and proper medication storage and documentation. However, a prohibited health condition was identified in one resident without an exception request submitted.
Deficiencies (1)
Resident 1 was admitted with a prohibited health condition without an exception request submitted to admit and retain the resident.
Report Facts
Resident records reviewed: 10
Staff interviewed: 5
Residents interviewed: 5
Bedrooms inspected: 10
Emergency disaster drill date: Mar 15, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lea Bogoyevac | Executive Director | Met with Licensing Program Analysts during the inspection. |
| Brian Balisi | Licensing Program Analyst | Conducted the inspection and signed the report. |
| Desaree Perera | Licensing Program Manager | Named in the report as Licensing Program Manager. |
Inspection Report
Annual Inspection
Census: 131
Capacity: 175
Deficiencies: 1
Date: Apr 15, 2024
Visit Reason
The inspection was a required unannounced annual visit to ensure the facility's compliance with Title 22 Regulations and to check for health and safety hazards.
Findings
The facility was found to be generally compliant with regulations, with properly furnished resident bedrooms, clean and functional bathrooms, adequate emergency and safety equipment, and proper medication storage and documentation. However, a records review revealed one resident admitted with a prohibited health condition without an exception request submitted.
Deficiencies (1)
Resident 1 was admitted with a prohibited health condition without an exception request submitted by the licensee.
Report Facts
Resident records reviewed: 10
Staff interviewed: 5
Residents interviewed: 5
Bedrooms inspected: 10
Emergency disaster drill date: Mar 15, 2024
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lea Bogoyevac | Executive Director | Met with LPAs during the inspection and named in the report. |
| Brian Balisi | Licensing Program Analyst | Conducted the inspection and signed the report. |
| Martha Arroyo | Licensing Program Analyst | Conducted the inspection. |
Inspection Report
Original Licensing
Census: 84
Capacity: 175
Deficiencies: 0
Date: Mar 16, 2023
Visit Reason
Licensing Program Analyst Martha Arroyo conducted a pre-licensing visit to the facility due to a change of ownership and to inspect for fire safety, personal accommodations and services, and food service.
Findings
The facility was found to be in compliance with Title 22 regulations, with adequate accommodations, safety measures, and proper storage and maintenance of medications, food, and supplies. Fire safety systems and emergency plans were functional and properly posted.
Report Facts
Non-ambulatory residents fire clearance: 165
Bedridden residents fire clearance: 10
Resident bedrooms: 147
Freezer temperature: 0
Refrigerator temperature: 40
Hot water temperature range: 105-120
Minimum heating temperature: 68
Maximum cooling temperature: 85
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lea Bogoyevac | Administrator | Applicant met during pre-licensing visit |
| Martha Arroyo | Licensing Program Analyst | Conducted the pre-licensing visit and inspection |
| Desaree Perera | Licensing Program Manager | Named in report header and signature |
Inspection Report
Original Licensing
Census: 84
Capacity: 175
Deficiencies: 0
Date: Mar 16, 2023
Visit Reason
Licensing Program Analyst Martha Arroyo conducted a pre-licensing visit to the facility due to a change of ownership and to evaluate compliance with licensing requirements.
Findings
The facility was inspected for fire safety, personal accommodations, services, and food service. The physical plant and safety systems were found to be in compliance with Title 22 regulations, with adequate accommodations, safety features, and cleanliness observed throughout the facility.
Report Facts
Fire clearance capacity: 165
Fire clearance capacity: 10
Resident bedrooms: 147
Hot water temperature range: 105
Hot water temperature range: 120
Freezer temperature: 0
Refrigerator temperature: 40
Facility capacity: 175
Current census: 84
Employees mentioned
| Name | Title | Context |
|---|---|---|
| Lea Bogoyevac | Administrator | Applicant met during pre-licensing visit |
| Martha Arroyo | Licensing Program Analyst | Conducted the pre-licensing inspection |
| Desaree Perera | Supervisor | Supervisor overseeing the licensing evaluation |
Report
January 23, 2026
Report
January 23, 2026
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