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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701234
Report Date: 06/18/2025
Date Signed: 06/18/2025 09:49:36 AM

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
04/07/2025 and conducted by Evaluator Pang Lee
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250407102227
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:
06/18/2025
UNANNOUNCEDTIME BEGAN:
08:24 AM
MET WITH:Lezel Bello TIME COMPLETED:
10:05 AM
ALLEGATION(S):
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Staff is not meeting residents’ medical needs
Staff does not ensure facility is free of pests
Facility does not provide variety food as required
INVESTIGATION FINDINGS:
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On 06/18/2025, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to this facility to conduct a complaint visit. LPA met with 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 35. A brief interview with conducted with administrator Lazel.

It was alleged that staff is not meeting residents’ medical needs. This investigation consisted of interviews with staff, residents, and an outside agency and records review. LPA Lee interviewed 3 out of 3 facility staff who denied the allegation. It was learned that the facility only monitors residents' blood sugar levels if there is a doctor's order in place. Administrator Lezel stated that currently, only three residents have such orders, and their blood sugar levels are being regularly monitored and managed by the facility.

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

DATE: 06/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025
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 6
Control Number 27-AS-20250407102227
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: 06/18/2025
NARRATIVE
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Furthermore, the Administrator explained that for residents without a doctor's order, the facility does not perform blood sugar checks. This is handled on a case-by-case basis. Some residents are seen by their primary care providers (PCPs) on varying schedules such as annually, quarterly, every six months, or as needed. During these visits, lab work is typically conducted, and any necessary care is directed by the PCP based on those results. The Administrator also confirmed that for residents whose blood sugar is being monitored, the readings are documented in a log and shared with their PCPs when necessary. Furthermore, LPA Lee interviewed 11 out of 11 residents, and none expressed concerns about their medical needs not being met by facility staff. LPA Lee also interviewed an outside agency that regularly visits the facility, who also reported no concerns regarding residents’ medical needs are not being met by the facility. A review of records confirmed that three residents have a doctor’s order authorizing the facility to monitor and assist with their blood glucose levels. The facility’s blood glucose monitoring log shows that glucose levels are being regularly tracked for Resident 1 (R1), Resident 2 (R2), and Resident 3 (R3). Based on interviews and record reviews during the investigation, LPA Lee was unable to corroborate the allegations.

It was alleged that staff does not ensure facility is free of pests. This investigation included interviews with staff, residents, and two outside agencies (OA), as well as observations and record reviews. LPA Lee interviewed 3 out of 3 facility staff who denied the allegation. 1 out of 11 residents, denied the allegation and stated they have not witness pest in their room nor in the facility and expressed no concern. In an interview with the two outside agencies, who both reported no concerns and had not observed any pests in the facility. Based on observations on 04/16/2025 and 06/05/2025, LPA toured multiple residents’ rooms in the main building, multiple residents’ rooms in the wall building, and multiple residents’ rooms in the Terrence Hall building and the TV room in Terrace Hall and found no evidence of roaches. A review of the facility’s records confirmed that the facility has maintained an active contract with All-in-One Pest Control Inc. since 10/10/22, with no gaps in service. The facility receives bi-monthly treatments for both the interior and exterior of the building, including resident bedrooms, as indicated in treatment logs from 04/08/25 through 06/10/25. Invoices provided show services were rendered from 04/08/24 to current, detailing the type and dates of service. Additionally, the facility’s maintenance staff, Carl, conducts its own pest control treatments on top of the services provided by the pest control company. Based on interviews, observations, and record reviews during the investigation, LPA Lee was unable to corroborate the allegations.


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

DATE: 06/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 27-AS-20250407102227
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: 06/18/2025
NARRATIVE
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It was alleged that facility does not provide variety food as required. This investigation included interviews with staff, residents, and two outside agencies, as well as observations and a review of facility records. LPA Lee interviewed all three facility staff members, who denied the allegation. Additionally, 8 out of 11 residents interviewed also denied the allegation, stating they have no concerns about the meals provided and that they like the food being served. LPA Lee also interviewed two outside agencies who reported no concerns and confirmed that a variety of meals are being offered to residents in care. During observations conducted on 04/16/25, 06/05/25 and during today’s visit 06/18/2025, LPA Lee observed both breakfast and lunch being served, noting a variety of food options available to residents. An inspection of the facility’s kitchen, refrigerator, and freezer also shows an adequate and varied food supplies. A review of facility records confirmed that the facility receives weekly food deliveries from Sysco and also does their own additional grocery orders from Walmart and Costco. Sysco delivery records also reflected a variety of food items being supplied to the facility. Based on the interviews, observations, and records reviewed, LPA Lee was unable to corroborate the allegation.

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: 06/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025
LIC9099 (FAS) - (06/04)
Page: 3 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
04/07/2025 and conducted by Evaluator Pang Lee
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20250407102227

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:
06/18/2025
UNANNOUNCEDTIME BEGAN:
08:24 AM
MET WITH:Lezel Bello TIME COMPLETED:
10:05 AM
ALLEGATION(S):
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Facility is malodorous
Administrator is not at the facility for sufficient number of hours at the facility.
INVESTIGATION FINDINGS:
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On 06/18/2025, Licensing Program Analyst (LPA) Pang Lee arrived unannounced to this facility to conduct a complaint visit. LPA met with 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 35. A brief interview with conducted with administrator Lazel.

It was alleged that the Administrator is not present at the facility for a sufficient number of hours. This investigation included interviews with staff, residents, and two outside agencies (OAs), as well as observations and a review of facility records. LPA Lee interviewed all three facility staff members, who stated that the previous Administrator, Hong Trinh (also known as Zoey), would visit the facility approximately once a week, but her visits were brief and primarily for checking on the facility. In an interview with 11 out of 11 residents who reported that they do not see Hong Trinh at the facility regularly and only observe staff member Lezel Bello on-site who is the individual they are directed to for any questions or concerns.

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

DATE: 06/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025
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-20250407102227
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: 06/18/2025
NARRATIVE
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Interviews with two outside agency representatives also confirmed that they rarely see Hong Trinh at the facility, noting that they typically only see Lezel Bello during their visits.

During facility visits conducted on 04/16/2025 and 06/05/2025, LPA Lee met with Lezel Bello, who informed Licensee Hong Trinh that CCLD was present at the facility. Hong Trinh later met with LPA Leet the facility on 04/16/2025. Hong Trinh previously served as the Administrator before appointing Lezel Bello as the new Administrator, effective 04/15/25. A review of the facility’s LIC 500 form, dated 04/16/2025, listed Hong Trinh as the Licensee/Administrator "on-call" with no set days or hours at the facility. Based on interviews, observations, and record reviews, LPA Lee was able to corroborate the allegation that the Administrator was not present at the facility for a sufficient number of hours.

It was alleged that the facility is malodorous. This investigation included resident interviews and direct observations. During interviews, 6 out of 11 residents reported having noticed an incontinence odor in the facility and expressed concern. During two separate facility visits, LPA Lee made the following observations: on 04/16/2025, resident bedroom #10 had a noticeable incontinence odor; on 06/05/2025, resident room #24 was noted to have a mild incontinence related smell. Based on resident interviews and these observations, LPA Lee was able to corroborate the allegation.

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: 06/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 27-AS-20250407102227
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: 06/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/25/2025
Section Cited
CCR
87405(a)
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87405(a) Administrator - Qualifications and Duties
(a) All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person. The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section.
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As of 04/15/25, the facility has appointed a new administrator Lazel Bello to the facility to ensure that the administrator is present at the facility for a sufficient numbers of hours to ensure adequate attention to manage the facility.
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This requirement is not met as evidenced by:

Based on observations, interviews and record reviews, the licensee did not comply with the section cited above. The administrator Hong Trinh was not at the facility for a sufficient numbers of hours to permit adequate permit adequate attention to the management of the facility. This poses a potential health, safety or personal rights risk to persons in care.
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Administrator will review the regulation cited and provided LPA Lee a statement of acknowledgement of reading and understanding the regulation cited.
Type B
06/25/2025
Section Cited
CCR
87625(b)(3)
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87625(b)(3) Managed Incontinence
(b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following:
(3) Ensuring that incontinent residents are kept clean and dry, and that the facility remains free of odors from incontinence.

This requirement is not met as evidenced by:
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Administrator stated the following plan will be put in place: staff will empty the resident trash and check resident room every two hours. Staff will check on resident bedding every 2 hours to see if it’s soil and if needed will change resident bedding.
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Based on observations on 04/16/25 and 06/05/25, LPA Lee observed incontinence smell in the facility. This poses a potential health, safety or personal rights risk to persons in care. This poses a potential health, safety or personal rights risk to persons in care.
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Administrator will generate a log regarding every two hours check and provide to LPA Lee from 06/19/2025 to 07/19/2025. Administrator will review the regulation cited and provided LPA Lee a statement of acknowledgement of reading and understanding the regulation cited.

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: 06/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6