Senior Care Records.

Complaint Investigation Report

Ivy Park at Hayward, Hayward12/05/2024Licence 019200922

Census105
Date signed12/05/2024 06:12:29 PM
The inspector’s account

During inspection, LPA observed roach traps with dead roaches in 2 residents apartments. LPA also observed dead roach in the kitchen cabinet in 1 of the apartments and stained carpet flooring and mattress leaning on the wall in this apartment, and another apartment with litter.

Based on interviews and observation, the preponderance of evidence has been met, therefore, the allegation is substantiated.

Deficiency is cited from Title 22 California Code of Regulations and listed on 9099D. A $250.00 civil penalty is assessed for repeat violation of section 87303(a) within 12 month period. Failure to submit proof of correction by plan of correction due date may result in additional civil penalty.

Deficiency and plan and proof of correction were discuss with AED.

Exit interview conducted. Appeal Rights, LIC421FC Civil Penalty Assessment, LIC9098 Proof of Correction form and copy of this report provided.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction