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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701234
Report Date: 08/28/2024
Date Signed: 08/28/2024 03:22:53 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/21/2024 and conducted by Evaluator Pang Lee
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240821100429
FACILITY NAME:IVY RIDGE ASSISTED LIVINGFACILITY NUMBER:
342701234
ADMINISTRATOR:HONG TRINH (ZOE)FACILITY TYPE:
740
ADDRESS:2030 23RD STTELEPHONE:
(916) 600-3309
CITY:SACRAMENTOSTATE: CAZIP CODE:
95818
CAPACITY:36CENSUS: 36DATE:
08/28/2024
UNANNOUNCEDTIME BEGAN:
11:09 AM
MET WITH:Lezel BelloTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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9
Staff did not ensure facility is free of pest.
INVESTIGATION FINDINGS:
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On 08/28/2024 at 11:09 AM, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to this facility to conduct a complaint visit. LPA met with Assistant Administrator Lezel Bello and explained the purpose of the visit. The purpose of this visit is to opened and delivered the complaint. The current census is 36. A brief interview with conducted with Administrator Hong Trinh.

Allegation: Staff did not ensure facility is free of pest.
It was alleged that staff did not ensure facility is free of pest. This investigation consisted of observations, interviews with staff and residents and records reviewed. Based on facility visits on 08/05/2024, 08/19/2024 and today’s visit 08/28/2024, LPA Lee did not observe any pest in the facility. LPA Lee interviewed 5 facility staff who denied the allegation and stated they have not seen any pest in the facility since the facility start services with pest control. LPA Lee also interviewed 7 out of 10 residents who stated they have not observed any roaches or other pest in the facility and have no concern with the allegation.
Continued LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 508-9726
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
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 27-AS-20240821100429
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: IVY RIDGE ASSISTED LIVING
FACILITY NUMBER: 342701234
VISIT DATE: 08/28/2024
NARRATIVE
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Based on records review the facility has a contract with “All-in-One Pest Control Inc” since 10/10/2022 and that there has not been any break in service. Furthermore, the facility is receiving treatment services twice a month. Based on All-in-One Pest Control Log treatments, the facility is getting treatment done in the interior of the building including resident bedrooms and exterior of the building. Log treatment also revealed that the facility received an exterior services on 08/27/2024.

The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that the complaint allegations are UNSUBSTANTIATED means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation(s)occurred.

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 6, no deficiencies were cited.
An exit interview was conducted, and a copy of this report was provided to Administrator Assistant Lezel Ballo.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 508-9726
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2