486803653-8-28-2025-21-AS-BMOS-DLBUBY-20250908152708

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803653
Report Date: 08/28/2025
Date Signed: 08/28/2025 02:41:49 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/11/2025 and conducted by Evaluator Star Stevenson

COMPLAINT CONTROL NUMBER: 21-AS-20250811222737

FACILITY NAME:	IVY PARK AT ROCKVILLE		FACILITY NUMBER:	486803653
ADMINISTRATOR:	TEDRA GODFREY		FACILITY TYPE:	740
ADDRESS:	4625 MANGELS BLVD		TELEPHONE:	(707) 356-2229
CITY:	FAIRFIELD	STATE: CA	ZIP CODE:	94534
CAPACITY:	199	CENSUS: 147	DATE:	08/28/2025
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	'Tetra Godfrey - Administrator		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff do not keep the facility free from a bug infestation

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

At approximately 2:30 PM, Licensing Program Analyst (LPA) Stevenson arrived unannounced to deliver findings for this Complaint Investigation regarding the above allegation and met with Administrator Tetra Godfrey.

During file review, it was determined that on 10/16/2024 Community Care Licensing (CCL) received a former complaint that Rockville Terrace under Calson management that “facility has bed bugs” and that complaint was substantiated on 10/22/2024. Then on 11/07/2024 CCL received a compliant that, “staff did not ensure facility was free from pests (bed bugs) and that allegation was unsubstantiated on 02/11/2024. Then on 02/26/2025 CCL received a complaint that, “Staff do not keep the facility free from bed bugs” that alligation was also unsubstantiated on 04/15/2025. Finally on 08/11/2025, CCL received a complaint that "staff do no keep facility free from a bug (bed) infestation".

Continued on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Star Stevenson
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025

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 21-AS-20250811222737

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: IVY PARK AT ROCKVILLE	FACILITY NUMBER: 486803653
	VISIT DATE: 08/28/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Continued from LIC9099
During the course of this investigation, the Department requested and reviewed documents, conducted interviews, and made observations. The most recent allegation of “Staff do not keep the facility free of pests.” Complainant stated that, "For months, since this facility has been taken over by Oakmont Management... residents rooms have been infested with bed bugs... no one has been putting any real effort to get rid of them:"
Ivy Park at Rockville had been using Clark Pest Control company but moved to Pinnacle Pest Control in the hopes of having more aggressive pest control. LPA obtained records of Pinnacle Pest performing both heat treatments and spray treatments to affected rooms from 05/14/2025 to 08/13/2025.

An interview with a representative from Pinnacle Pest Control also revealed their desire to have Ivy Park at Rockville use bed bug sniffing dogs to inspect the entire building. On June 11th, 2025, dog(s) from Harlem River Hounds identified nine (9) rooms which were subsequently treated by Pinnacle Pest Control. In addition, LPA learned that at least four (4) of the current maintenance/housekeeping staff were taught specific bed bug handling techniques by representatives from Clark Pest Control before current management took over in April of 2025. Pinnacle Pest Control expects to begin two hour training sessions with staff at Ivy Park at Rockville, but has not yet started.

Finally, LPA observed on-going larger pest traps, typically used to target rodents strategically placed outside the building by Ecolab company.

Based on observations made, records reviewed and interviews conducted, this allegation is Unsubstantiated. A finding that the complaint allegation is Unsubstantiated means that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

No Deficiencies Cited during visit.

Exit interview conducted. Copy of report discussed and provided to Tetra Godfrey - Administrator
Signature on form confirms receipt of documents.

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Star Stevenson
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 2