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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803653
Report Date: 08/29/2025
Date Signed: 08/29/2025 01:46:29 PM

Unfounded


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
07/10/2025 and conducted by Evaluator Ali Deniz
COMPLAINT CONTROL NUMBER: 21-AS-20250710164113
FACILITY NAME:IVY PARK AT ROCKVILLEFACILITY NUMBER:
486803653
ADMINISTRATOR:TEDRA GODFREYFACILITY TYPE:
740
ADDRESS:4625 MANGELS BLVDTELEPHONE:
(707) 356-2229
CITY:FAIRFIELDSTATE: CAZIP CODE:
94534
CAPACITY:199CENSUS: 146DATE:
08/29/2025
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Administrator, Tedra Godfrey. TIME COMPLETED:
02:05 PM
ALLEGATION(S):
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Staff are not allowing resident to have visitors
INVESTIGATION FINDINGS:
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At approximately 12:45PM, Licensing Program Analyst (LPA) Deniz arrived unannounced to continue a complaint Investigation and delivered the findings regarding the above allegation and met with Administrator, Tedra Godfrey.
During the investigation, the Department requested and reviewed documents, conducted interviews, and made observations. The following allegation was investigated, “Staff are not allowing resident to have visitors”. The complainant alleged that residents were being restricted from visiting with others. Specifically, Resident R1 indicated that on July 10, 2025, Visitor F1 was not permitted to visit due to concerns about maintaining a balance between both residents involved and the potential to trigger a fall/injury.
Per interview, Staff S1 provided information regarding the facility’s visitor policy and explained how visitations are managed. S1 noted that F1 has short-term memory loss and may sometimes forget who they are visiting, or how to find the room of the resident they would like to visit, which has led to instances where F1 appeared confused or became lost during visits.

Continued on LIC9099-C...
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Ali Deniz
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2025
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-20250710164113
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: 08/29/2025
NARRATIVE
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Continued from LIC9099...

Interviews were conducted with both F1 and S1. F1 clearly expressed to the LPA that they are free to choose whom they visit, and that caregivers have consistently been helpful and supportive of visits. F1 emphasized that they make their own decisions regarding visitation and have not felt restricted by staff.
Based on interviews, observations, and documentation reviewed, the investigation revealed that residents are allowed visitors and there was no evidence to support the claim that staff were preventing visitations, therefore the allegation is UNFOUNDED means that the allegation was false, could not have happened and/or is without a reasonable basis.

Exit interview was conducted and a copy of this report was signed and given to the Administrator.
SUPERVISORS NAME: Victoria Bertozzi
LICENSING EVALUATOR NAME: Ali Deniz
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2