342701234-7-7-2023-27-AS-KHOS-CTMLSD-20230711090034

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342701234
Report Date: 07/07/2023
Date Signed: 07/07/2023 03:39:43 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/28/2023 and conducted by Evaluator Tung Truong

COMPLAINT CONTROL NUMBER: 27-AS-20230428124612

FACILITY NAME:	IVY RIDGE ASSISTED LIVING		FACILITY NUMBER:	342701234
ADMINISTRATOR:	KITNIKONE, SUNNIE		FACILITY TYPE:	740
ADDRESS:	2030 23RD ST		TELEPHONE:	(916) 600-3309
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95818
CAPACITY:	36	CENSUS: 28	DATE:	07/07/2023
		UNANNOUNCED	TIME BEGAN:	01:40 PM
MET WITH:	Hong Trinh		TIME COMPLETED:	03:50 PM

ALLEGATION(S):

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Lack of resident supervision resulting in residents becoming lost at neighboring homes
Residents are isolated in their room by staff as punishment for wandering away from the facility
Staff yell at residents
Staff handled resident in a rough manner
Staff do not treat residents wih dignity or respect

INVESTIGATION FINDINGS:

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On 7/7/2023, Licensing Program Analyst (LPA) Tung Truong conducted an unannounced visit to this facility to deliver the findings for a complaint investigation. LPA met with Licensee Hong Trinh and explained the purpose of today’s visit.

Throughout the course of the investigation, LPA Truong conducted interviews and reviewed records. Based on interviews and records review, the allegations mentioned above were deemed unfounded. According to interviews conducted with residents, staff and surrounding neighbors, no one could corroborate on the allegations. No other supporting information to the allegations above was discovered.
Complaint is deemed to be unfounded at this time.

Continued on 9099-C

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Tung Truong	TELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20230428124612

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: IVY RIDGE ASSISTED LIVING	FACILITY NUMBER: 342701234
	VISIT DATE: 07/07/2023

NARRATIVE

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As a result of this investigation, this LPA finds the allegations above to be UNFOUNDED, meaning that the allegations were false, could not have happened and/or was without a reasonable basis. This Department has therefore dismissed the complaint.

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no violations were cited during this visit. An exit interview was conducted, and a copy of this report was provided.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Tung Truong	TELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

LIC9099 (FAS) - (06/04)

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