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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701234
Report Date: 12/17/2024
Date Signed: 12/17/2024 03:07:26 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
10/03/2024 and conducted by Evaluator Pang Lee
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20241003083728
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: 34DATE:
12/17/2024
UNANNOUNCEDTIME BEGAN:
01:43 PM
MET WITH:Lezel BelloTIME COMPLETED:
03:20 PM
ALLEGATION(S):
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Staff handle resident in rough manner while in care.
Staff speak inappropriately to residents in care.
Resident is sustaining unexplained injuries while in care.
Facility freezer is in disrepair.
Licensee is not addressing bed bug infestation at the facility.
Staff stole from resident in care.



INVESTIGATION FINDINGS:
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On 12/17/2024, 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 34. A brief interview with conducted with administrator Lezel.

An allegation was made that staff handle residents in a rough manner while in care and staff speak inappropriately to residents. The investigation included a review of records and interviews with staff and residents. LPA Lee interviewed 7 out of 7 residents, who each stated that they are not being handled in a rough manner and spoken to inappropriately by facility staff. Additionally, LPA Lee interviewed another individual from an outside agency, who reported not witnessing any instances of residents being handled roughly or spoken to inappropriately.

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

DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
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 6
Control Number 27-AS-20241003083728
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: 12/17/2024
NARRATIVE
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Treatment dates include September 10, 2024; September 24, 2024; October 8, 2024; October 22, 2024; November 12, 2024; November 26, 2024; and December 10, 2024. Based on interviews 7 out of 7 residents confirmed that they have not seen any bed bugs in their rooms or in the facility. Furthermore, five facility staff members denied the allegation. Additionally, LPA Lee interviewed another individual from an outside agency, who reported not witnessing any bedbugs in resident’s room. Based on the interviews, observations, and record review, there is no preponderance of evidence to support the claim of a bed bug infestation. Therefore, the allegation is unsubstantiated.

An allegation was made that staff stole from resident in care. The investigation included interviews with both residents and facility staff. Based on these interviews, 7 out of 7 residents interviewed reported no concerns regarding staff stealing from residents. Additionally, five of the facility staff members interviewed denied the allegation. Through the investigation, it was learned that resident 2 (R2) had $200 and gave $100 to staff 1 (S1) to purchase groceries on R2’s behalf. S1 then reported and gave $100 to Assistant Administrator Lezel, who then returned the money to R2’s wallet and informed R2. When interviewed, R2 confirmed that $100 was given to a staff member and that the money was returned. However, R2 also stated uncertainty about what happened to the money; therefore, it is unclear what had happened to R2’s $100. After reviewing all interviews there is insufficient evidence to determine whether the alleged allegation did or did not occur. Therefore, the allegation is unsubstantiated.


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.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 27-AS-20241003083728
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: 12/17/2024
NARRATIVE
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Five facility staff members interviewed also denied the allegations. Based on the information and interviews gathered, there is no preponderance of evidence to support the claim. Therefore, the allegation is unsubstantiated.

An allegation was made that residents sustain unexplained injuries while in care. The investigation included observations, a review of records, and interviews with facility staff and residents. During visits to the facility on October 7, 2024, and November 7, 2024, LPA Lee did not observe bruises on Resident 1 (R1) or other residents. However, LPA Lee did observe old scabs on R1’s arm. Based on interviews staff stated that R1’s scabs are a result of R1’s use of blood thinner medication and bumping into objects. Records confirmed that R1 is on blood thinner medication. LPA Lee interviewed 7 out of 7 residents, all of whom denied any abuse by facility staff. R1 also stated that R1 tends to bump into things, which is how R1 sustained bruises and scabs. Furthermore, R1 indicated that R1 has no concerns regarding care. Additionally, LPA Lee interviewed another individual from an outside agency, who reported not observing any residents having bruises and injuries. Based on the interviews, observations, and information gathered, there is no preponderance of evidence to support the claim. Therefore, the allegation is unsubstantiated.

An allegation was made that the facility freezer is in disrepair. The investigation included observations and interviews with facility staff. On October 7, 2024, and November 7, 2024, LPA Lee observed the freezer’s temperature to be -23°C and noted that it appeared to be in good repair. Additionally, the produce in the freezer was properly frozen with no signs of freezer burn or frostbite. Five facility staff members interviewed denied the allegation that the freezer is in disrepair. Based on the observations and interviews conducted, there is no preponderance of evidence to support the claim. Therefore, the allegation is unsubstantiated.

An allegation was made that the licensee is not addressing a bed bug infestation at the facility. The investigation included observations, a review of records, and interviews with residents and facility staff. On October 7, 2024, and November 7, 2024, LPA Lee toured the facility, including resident bedrooms and mattresses, and did not observe any bed bugs. A review of the facility’s records confirmed that the facility has maintained an active contract with All-in-One Pest Control Inc. since October 10, 2022, with no gaps in service. Additionally, the facility is receiving treatment services twice a month. The All-in-One Pest Control treatment logs indicate that the facility has received services in both the interior and exterior of the building, including resident bedrooms.

Continued LIC 9099-C

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 6
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
10/03/2024 and conducted by Evaluator Pang Lee
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20241003083728

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: 34DATE:
12/17/2024
UNANNOUNCEDTIME BEGAN:
01:43 PM
MET WITH:Lezel BelloTIME COMPLETED:
03:20 PM
ALLEGATION(S):
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Staff do not follow proper food service sanitation practices.
Staff are serving expired food to residents in care.
INVESTIGATION FINDINGS:
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On 12/17/2024, 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 34. A brief interview with conducted with administrator Lezel.

It was alleged that staff are not adhering to proper food service sanitation practices and are serving expired food to residents in care. An investigation was conducted, including observations and interviews with kitchen staff. On October 7, 2024, LPA Lee and Ombudsman Suhair Siraj toured the kitchen and inspected the facility's refrigerator and freezer. Multiple bags of bagels, hot dog buns, waffles, ham, hash browns, sausage bites, and bread were found in the freezer without any visible expiration dates. When questioned about how they determine when to dispose of food lacking expiration dates, the three kitchen staff members responded, “I don’t know.”
Continued LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
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 6
Control Number 27-AS-20241003083728
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: 12/17/2024
NARRATIVE
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On November 7, 2024, LPA Lee revisited the kitchen to inspect the freezer and refrigerator. During this inspection, 10 packages of pancakes, 2 packs of hot dog buns, 1 pack of waffles, and 1 pack of toast were observed in the freezer, with none displaying expiration dates, creating uncertainty about their freshness. Additionally, on October 7, 2024, LPA and Ombudsman observed two kitchen staff members preparing lunch for residents without wearing gloves and hair nets. One kitchen staff was observed cutting chicken without gloves and hair nets. When questioned by LPA Lee and Ombudsman Siraj why the staff was not wearing gloves staff explained that he/she had already washed their hands. Furthermore, it was noticed that a bag of frozen chicken breast was left in the kitchen sink, sitting in a bowl of water to thaw.

As a result, this allegation is 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 Tasha and Melissa 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: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 6
Control Number 27-AS-20241003083728
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: 12/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/30/2024
Section Cited
CCR
87555(b)(8)
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87555 General Food Service Requirements
(b) The following food service requirements shall apply:
(8) All food shall be of good quality…

This requirement is not met as evidenced by:
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Administrator agrees to remove all expired food from facility and write a plan for storage and labeling of food in freezer. Administrator agrees to read the regulation cited and provide LPA Lee a statement of acknowledge of the regulation cited by POC date 12/30/24 end of day 5:00 PM.
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Based on observation and interview, the licensee did not comply with the section cited above. Administrator didn’t ensure that multiple 2 days perishable food in the freezer had an expiration date. During interview when question the expiration date on the packages of 2 days perishable 3 facility staff stated, “I don’t know.” This poses an immediate
health, safety or personal rights risk to persons in care.
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Type A
12/30/2024
Section Cited
CCR
87555(b)(15)
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87555 General Food Service Requirements
(b) The following food service requirements shall apply:
(15) All persons engaged in food preparation and service shall observe personal hygiene and food services sanitation practices which protect the food from contamination.

This requirement is not met as evidenced by:
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Administrator will provide in-service to General Food Service Requirements and provided LPA Lee staff sign in sheet. Administrator agrees to read the regulation cited and provide LPA Lee a statement of acknowledge of the regulation cited by POC date 12/30/24 end of day 5:00 PM.
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Based on observation and interview, the licensee did not comply with the section cited above. Administrator didn’t ensure that food services sanitation practices are conducted when LPA observed facility staff now wearing gloves and hair net. It was also observed chicken was left to thaw out in the kitchen sink inside a bowl with water. This poses an immediate health, safety or personal rights risk to persons 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: 12/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 6