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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701234
Report Date: 10/10/2024
Date Signed: 10/10/2024 02:02:02 PM

Substantiated


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
07/30/2024 and conducted by Evaluator Pang Lee
COMPLAINT CONTROL NUMBER: 27-AS-20240730114922
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: 35DATE:
10/10/2024
UNANNOUNCEDTIME BEGAN:
01:01 PM
MET WITH:Lezel BelloTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Unlawful eviction.
Staff did not ensure the shower was not in disrepair.
INVESTIGATION FINDINGS:
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On October 9, 2024, at 1:00 PM, Licensing Program Analyst (LPA) Pang Lee arrived unannounced at the facility to conduct a complaint visit. LPA Lee met with Lezel Bello and explained the purpose of the visit: to deliver findings regarding the allegations mentioned above. The current resident census is 35. A brief interview was conducted with Administrator Assistant Lezel Bello.

The department investigated the complaint alleging an unlawful eviction and alleging that staff did not ensure the shower was not in despair. The investigation revealed that Resident 1 (R1) received an eviction letter on August 1, 2024, due to frequent non-emergency calls made through the pull cord system and the main office phone line. R1 had moved into the facility on July 15, 2024. Records from the Emergency Call Log indicate that from July 15 to July 31, 2024, R1 activated the call system 26 times. The admission agreement and house rules do not specify a limit on call usage. Furthermore, R1 did not violate any conditions such as non-payment, failure to comply with state or local laws, or non-adherence to community policies. Consequently, the eviction was deemed unlawful, with deficiency documented on form LIC 9099-D.
Continued LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024
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 5
Control Number 27-AS-20240730114922
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: 10/10/2024
NARRATIVE
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Additionally, observations made on August 5, 2024, and an interview with Administrator Hong Trinh revealed that two shower heads in the upstairs Terrace Hall building were intentionally removed. This decision was made because a resident frequently left the water running, causing overflow into the hallway. Based on the investigation, the Department finds the allegations to be substantiated, meaning the claims are valid and meet the preponderance of evidence standard. Deficiencies are cited on LIC 9099-D, in accordance with Title 22 Regulations.

As a result, these allegations are SUBSTANTIATED. A finding that the complaint is substantiated means that the allegations are valid because the preponderance of the standard has been met. Deficiencies cited on the LIC 9099-D, per Title 22 Regulations. An exit interview was conducted with licensee and a copy of this LIC 9099, LIC 9099-D page and appeal rights provided to facility.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 27-AS-20240730114922
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/18/2024
Section Cited
CCR
8722(a)
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87224(a) Eviction Procedures
(a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5) …

This requirement was not met as evidence by:
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Administrator agrees to review eviction regulations by POC date 10/18/24. Administrator agrees to provide a written statement to LPA via email that states the review of eviction regulations has been completed by POC Date 10/18/24 by end of day 5:00 PM

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Based on record review and interviews, R1 was evicted due to due to frequent non-emergency calls made through the pull cord system and the main office phone line. This poses a potential health and safety to residents in care.
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Type B
10/18/2024
Section Cited
CCR
87303(a)
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87303(a) Maintenance and Operation
(a) The facility shall be clean, safe, sanitary and in good repair at all times…

This requirement was not met as evidence by:
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Administrator agrees to ensure that the facility is in good repair at all times. Administrator will also put the shower head back on to the shower in the Terrence building and send via email LPA a picture of the two shower heads in the Terrence building by end of day 10/17/2024 5:00 PM.
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Based on observation and interviews the administrator did not ensure that resident’s shower was in good repair. This poses a potential health and safety to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
07/30/2024 and conducted by Evaluator Pang Lee
COMPLAINT CONTROL NUMBER: 27-AS-20240730114922

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: 35DATE:
10/10/2024
UNANNOUNCEDTIME BEGAN:
01:01 PM
MET WITH:Lezel BelloTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff yelled at resident
Staff did not ensure that the AC was not in disrepair
Staff are not providing adequate food service to resident
Staff did not ensure resident had access to Wi-Fi
Staff are not meeting resident's needs
INVESTIGATION FINDINGS:
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On October 9, 2024, at 1:00 PM, Licensing Program Analyst (LPA) Pang Lee arrived unannounced at the facility to conduct a complaint visit. LPA Lee met with to Lezel Ballo explain the purpose of the visit: to present findings regarding the allegations mentioned above. The current resident census is 35. A brief interview was conducted with Lezel Ballo.

Allegation were made regarding staff yelling at a resident. The investigation involved interviews with both staff and residents. Based on the interviews and statements collected, LPA Lee was unable to corroborate the allegations. Out of 10 residents interviewed, 9 reported they had not witnessed any staff yelling at residents and had no concerns. Additionally, all 5 staff members interviewed denied the allegations.

Continued LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20240730114922
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: 10/10/2024
NARRATIVE
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Allegations were made that staff failed to ensure the air conditioning (AC) was in proper working order. The investigation included observations and interviews with staff and residents. During visits on 08/05/2024 and 08/28/2024, temperatures in the common building, Terrence building, and Wall building were all recorded below 85 degrees Fahrenheit which is within the required regulation of 78 to 85 degrees Fahrenheit. LPA Lee also noted that the facility's AC was in good repair on both occasions. Interviews conducted during the investigation revealed that 7 out of 10 residents had no concerns about the facility’s temperature. Additionally, all 5 staff members interviewed denied the allegations.

Allegations were made that staff were not providing adequate food service to residents. The investigation included observations and interviews with staff and residents. On 08/05/2024 and 08/28/2024, LPA Lee observed that the facility had a sufficient supply of perishable food for 2 days and nonperishable food for 7 days. During both visits, LPA Lee noted that appropriate portions of food were served to residents at breakfast and lunch. Interviews conducted during the investigation revealed that 7 out of 10 residents had no concerns about the adequacy of food service. Additionally, all 5 staff members interviewed denied the allegations.

Allegations were made that staff did not ensure residents had access to Wi-Fi. The investigation included observations and interviews with staff and residents. On 08/05/2024 and 08/28/2024, LPA Lee observed that the facility's Wi-Fi was functioning properly. Administrator Hong Trinh informed the LPA that a Wi-Fi booster had been installed in the Terrence building. Interviews conducted during the investigation revealed that 7 out of 10 residents had no concerns about access to Wi-Fi. Additionally, all 5 staff members interviewed denied the allegations.

Allegations were made that staff were not meeting residents' needs. The investigation involved interviews with staff and residents. Based on the statements obtained, LPA Lee was unable to corroborate the allegations. Out of 10 residents interviewed, 9 reported no concerns about staff not meeting their needs. Additionally, all 5 staff members interviewed denied the allegations.
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.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5