342701234-2-12-2025-27-AS-CACL-DDV6J9-20250213195047

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342701234
Report Date: 02/12/2025
Date Signed: 02/12/2025 03:13:07 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
12/17/2024 and conducted by Evaluator Pang Lee

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20241217105430

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: 33	DATE:	02/12/2025
		UNANNOUNCED	TIME BEGAN:	02:31 PM
MET WITH:	Lezel Bello		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff did not assist resident in a timely manner.
Staff not preventing resident’s sleep from being disturbed by another resident.
Staff is retaliating against resident.
Staff not providing resident with meals in a timely manner.

INVESTIGATION FINDINGS:

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On 02/12/25, 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 33.
It was reported that the facility staff did not assist a resident in a timely manner. The investigation involved interviews with staff, residents, and a review of records. LPA Lee interviewed 6 out of 7 residents who stated that they had no concerns about staff not assisting residents promptly. Additionally, these 6 residents reported they had not witnessed any falls where a resident was left unattended by staff. They also shared that they feel safe living in the facility. LPA Lee also interviewed 2 staff member and it was learned that Resident 1 (R1) experienced an unwitnessed fall in the bathroom. However, R1 was assisted promptly by care staff who heard the fall. The assistant administrator called EMTs, and R1 was transported to the hospital, returning the same day. A review of the records dated 11/22/24 confirmed the unwitnessed fall and the hospital transport. Furthermore, there were no records in the facility's electronic files indicating that (R2) having an unwitnessed fall.

Continued LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025

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 3

Control Number 27-AS-20241217105430

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: 02/12/2025

NARRATIVE

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The assistant administrator called EMTs, and R1 was transported to the hospital, returning the same day. A review of the records dated 11/22/24 confirmed the unwitnessed fall and the hospital transport. Furthermore, there were no records in the facility's electronic files indicating that (R2) having an unwitnessed fall.

It was alleged that staff are not preventing resident from disturbing another resident's sleep. The investigation involved interviews with both staff and residents. LPA Lee interviewed 6 out of 7 residents, who reported no concerns regarding staff not preventing sleep disturbances caused by another resident. Additionally, these 6 residents stated that they enjoy (R3) guitar playing and have no issues with it. LPA Lee also interviewed 2 facility staff members, both of whom denied the allegations. They stated that R3 has the right to play the guitar, and that the assistant administrator has spoken with R3 about being considerate of other residents while playing. Through the interviews, it was discovered that R3 typically plays the guitar from noon to evening. It was also noted that (R4) usually goes to bed between 3:00 PM and 4:00 PM and wakes up around 12:00 AM to 1:00 AM.

It was reported that staff are retaliating against resident. The investigation involved interviews with both staff and residents, as well as observations. LPA Lee interviewed 6 out of 7 residents, who stated that they had no concerns and had not witnessed any staff members retaliating against residents in care. Two staff members at the facility were also interviewed and denied the allegations. During both visits on 11/27/24 and 12/24/24, LPA Lee did not observe any mistreatment or retaliation by staff against residents in care.

It was alleged that staff are not providing residents with meals in a timely manner. The investigation involved interviews with staff and residents, observations, and a review of records. LPA Lee interviewed 6 out of 7 residents, who reported no concerns about delays in receiving meals. Several residents mentioned that they either go to the dining room for their meals or have meals delivered to their rooms if they are unable to go to the dining room. Two facility staff members denied the allegations, explaining that if meals are delayed, it is usually by 10-15 minutes due to staffing or other factors affecting the schedule; however, that residents always receive their meals. During observations on 12/24/24, LPA Lee observed residents eating lunch around 12:15 PM. During today’s visit, LPA Lee observed at 12:55 residents were finishing their lunch. Records review revealed that breakfast is served from 8:00-9:00 AM, lunch from 12:00-1:00 PM, and dinner from 5:00-6:00 PM. Additionally, text messages confirmed that R4’s lunch was served within the designated mealtime frames.

Continued LIC 9099-C

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 27-AS-20241217105430

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: 02/12/2025

NARRATIVE

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Based on statements obtained, records review and observations during the investigation process, LPA was unable to corroborate 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.

SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Pang Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 02/12/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025

LIC9099 (FAS) - (06/04)

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