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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347005512
Report Date: 07/20/2026
Date Signed: 07/20/2026 12:39:36 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
05/28/2026 and conducted by Evaluator Shakaricka Hughes
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20260528140537
FACILITY NAME:IVY PARK AT LAGUNA CREEKFACILITY NUMBER:
347005512
ADMINISTRATOR:KARANDEEP BASSIFACILITY TYPE:
740
ADDRESS:6727 LAGUNA PARK DRTELEPHONE:
(916) 683-1881
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY:108CENSUS: 87DATE:
07/20/2026
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Administrator: Karendeep BassiTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff not present/available in a timely manner to meet resident(s) care needs.
INVESTIGATION FINDINGS:
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On 07/20/2026, Licensing Program Analyst (LPA) arrived unannounced to this facility to conduct a complaint visit. LPA met with the administrator Karan Bassi and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the allegation above. The current census is 87.

Allegation: Staff not present/available in a timely manner to assist emergency personnel with resident information during emergencies.
It was alleged that staff did not present resident information in a timely manner to assist during emergencies. This investigation consisted of interviews with facility staff, facility observation and records review. 06/01/2026, LPA Hughes conducted a visit to the facility and spoke with the Health Services Director, who stated that caregivers and medication technicians are trained to respond to emergency calls and situations. It was further stated that the facility is in the process of relocating resident records and prior to the relocation, staff were unaware of where resident information was stored and how to respond during emergencies.

Continuation 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Arielle Pascua
LICENSING EVALUATOR NAME: Shakaricka Hughes
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2026
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
Citations on this Visit Report are Under Appeal!

Control Number 27-AS-20260528140537
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 PARK AT LAGUNA CREEK
FACILITY NUMBER: 347005512
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/20/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type B
07/22/2026
Section Cited
CCR
87506(a)
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87506 Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff.

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The facility stated that a plan has been implemented to ensure that resident records are readily available for facility staff to assist emergency personnel in any event of emergency.
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This requirement was not met as evidenced by:
The facility did not ensure that resident records were complete, organized, and readily available to facility staff during emergencies.
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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.
SUPERVISOR'S NAME: Arielle Pascua
LICENSING EVALUATOR NAME: Shakaricka Hughes
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 27-AS-20260528140537
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 PARK AT LAGUNA CREEK
FACILITY NUMBER: 347005512
VISIT DATE: 07/20/2026
NARRATIVE
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 LPA toured the facility, and observed 911 health packets containing resident identification, medication lists, allergies, primary diagnosis, and DNR notifications. However, LPA observed that only 3 of the facility’s 14 resident rooms contained emergency health packets. Additionally, LPA reviewed resident records and observed that resident files were incomplete and disorganized, which could delay staff’s ability to provide emergency personnel with necessary resident information in a timely manner during an emergency. This was observed not in compliance with Title 22 regulation 87506(a) as the facility did not ensure resident records were complete, organized, and readily available to facility staff during emergencies.

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 evidence standard has been met. Deficiencies cited on the LIC 9099-D, per Title 22 Regulations. An exit interview was conducted and a copy of the LIC 9099, LIC 9099-D pages and appeal rights were provided to facility.
 
SUPERVISORS NAME: Arielle Pascua
LICENSING EVALUATOR NAME: Shakaricka Hughes
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3