342701234-8-28-2024-27-AS-KHOS-D8TNNY-20240905103731

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342701234
Report Date: 08/28/2024
Date Signed: 08/28/2024 03:24:04 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
08/01/2024 and conducted by Evaluator Pang Lee

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20240801135600

FACILITY NAME:	IVY RIDGE ASSISTED LIVING		FACILITY NUMBER:	342701234
ADMINISTRATOR:	HONG TRINH (ZOE)		FACILITY TYPE:	740
ADDRESS:	2030 23RD ST		TELEPHONE:	(916) 600-3309
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95818
CAPACITY:	36	CENSUS: 36	DATE:	08/28/2024
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Lezel Ballo		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff did not provide clean linens for resident in care.
Facility staff did not provide adequate laundry service to resident in care.

INVESTIGATION FINDINGS:

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

On 08/28/2024 at 12:30 PM, 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 deliver complaint findings for the allegations above. The current census is 36. A brief interview with conducted with Administrator Hong Trinh.

Allegations: Facility staff did not provide clean linens for resident in care and facility staff did not provide adequate laundry service to resident in care.

It was alleged that facility staff did not provide clean linens for resident in care and that facility staff did not provide adequate laundry service to resident in care. 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 observed facility staff doing laundry.
Continued LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang Lee	TELEPHONE: (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-20240801135600

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

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

LPA Lee also observed multiple baskets in the laundry room waiting to be washed once the laundry in the washer has completed its cycle. LPA Lee also toured and observed resident bedrooms in the main building, wall building and Terrence Hall to have clean bedding and linens. LPA Lee also observed the linen closet, and it was observed that the facility has sufficient clean linens for residents in care. LPA Lee interviewed 5 facility staff who denied the allegations and stated that resident’s laundry and linens are being washed every day. LPA Lee also interviewed 9 out of 10 residents who stated that they no concern with the allegations and are getting their laundry done by facility staff. 9 out of 10 residents also stated they are provided with clean linens from facility staff. Based on Laundry Schedule it was learned that residents are scheduled to have two to three days of laundry a week and as needed.

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-Lee	TELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang Lee	TELEPHONE: (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