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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019201599
Report Date: 05/29/2026
Date Signed: 05/29/2026 05:09:11 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
05/21/2026 and conducted by Evaluator David Doidge
COMPLAINT CONTROL NUMBER: 15-AS-20260521093633
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:
05/29/2026
UNANNOUNCEDTIME BEGAN:
04:15 PM
MET WITH:Executive Director Daniela RivasTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Due to lack of supervision, resident from the 2nd floor (memory care) accessed the elevator up to the 3rd floor
INVESTIGATION FINDINGS:
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On 05/29/2026 at 4:15 PM, Licensing Program Analyst (LPA) David Doidge arrived unannounced to conduct an initial 10-day complaint investigation and to deliver findings regarding the allegation above. LPA met with Executive Director Daniela Rivas and explained the purpose of the visit.

During the course of the investigation, LPA obtained copies of the Physician’s Reports, Appraisals Needs and Services for one resident (R1). LPA interviewed S1.

Allegation: Due to lack of supervision, resident from the 2nd floor (memory care) accessed the elevator up to the 3rd floor

Investigation Findings: It was reported to the department that a resident was able to access the elevator and ride it from one floor to another. The facility consists of three floors: ground, first and second.

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

DATE: 05/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2026
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-20260521093633
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: 05/29/2026
NARRATIVE
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Continued on LIC9099

S1 informed LPA that R1 rode the elevator from the second floor down to the first floor. R1 frequently waits by the elevator on the second floor to ride it down to the first floor to visit with residents who live on the first floor. Residents are allowed to go between floors to visit one another and for activities. The elevator can only be called with a key fob issued to staff, however once in the elevator anyone can press a floor and go to that floor. To leave the facility one would have to walk past the concierge desk which is always staffed. Staff are aware of R1’s behavior and look out for R1. The concierges also know R1 will ride the elevator and look out for R1 to prevent R1 from walking out the front door. There are no other direct exits one could take without a staff member seeing that could lead to a resident eloping. LPA reviewed the staff roster that shows six staff per floor during wake hours. LPA walked the facility and observed six staff on both floors. Based on interview and LPA’s observation the above allegation is UNSUBSTANTIATED.

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 allegation is UNSUBSTANTIATED.

No deficiencies were cited during this inspection.

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

DATE: 05/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2026
LIC9099 (FAS) - (06/04)
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