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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019201599
Report Date: 05/19/2026
Date Signed: 05/19/2026 03:49:12 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/18/2026 and conducted by Evaluator David Doidge
COMPLAINT CONTROL NUMBER: 15-AS-20260518131634
FACILITY NAME:IVY PARK AT LAKE MERRITTFACILITY NUMBER:
019201599
ADMINISTRATOR:HAYWOOD, GRANTFACILITY TYPE:
740
ADDRESS:468 PERKINS STREETTELEPHONE:
(510) 444-4684
CITY:OAKLANDSTATE: CAZIP CODE:
94610
CAPACITY:70CENSUS: 56DATE:
05/19/2026
UNANNOUNCEDTIME BEGAN:
12:36 PM
MET WITH:Executive Director Daniela RivasTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Facility elevator is in disrepair.
INVESTIGATION FINDINGS:
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On 05/19/2026 at 12:30 PM, Licensing Program Analyst (LPAs) David Doidge and Carol Folwer arrived unannounced to conduct an initial 10-day complaint investigation and deliver findings regarding the allegations above. LPAs met with Executive Director Daniela Riva sand explained the purpose of the visit.

During the course of the investigation, LPAs interviewed staff and toured the facility using both elevators.

Allegation: Facility elevator is in disrepair

Investigation Findings: It was reported to the department that the general manager of the facility is forcing staff to use an unworking elevator even though there is a working one which is causing an unsafe environment. S1 reported that the door sensor to the facility’s freight elevator is broken causing the door to slowly close.

Continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: David Doidge
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2026
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 15-AS-20260518131634
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: IVY PARK AT LAKE MERRITT
FACILITY NUMBER: 019201599
VISIT DATE: 05/19/2026
NARRATIVE
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Continued from LIC9099

S1 reported that the elevator is still safe to use, staff have been updating as to the circumstances and have the option to use whichever elevator they wish. S1 and S2 both reported no mandates nor obligation on staff as to which elevator to use. LPAs rode the freight elevator and observed that the door will close about a quarter of the way, then open and close in the same manner three to four times. The elevator door sensor will then alarm as it slowly closes. Once closed the elevator operates as normal. S1 informed LPAs that there is a service plan to change the door sensor. S1 reported that the company servicing the elevator, Otis, is currently sourcing the part and once available will change the senor. LPAs observed staff using both elevators freely, and both elevators in operational condition. Staff riding on the elevators reported no mandate for staff on elevator use. Staff did mention that management prefers staff use the freight elevators for building tasks, but there is no restrictions in place. Based on interviews conducted and LPAs observations the above allegation is UNSUBSTANTIATED.

Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

No deficiencies were cited during this inspection.

Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: David Doidge
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2