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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 455001869
Report Date: 10/17/2023
Date Signed: 10/17/2023 09:16:22 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
06/27/2023 and conducted by Evaluator Donna Gurriere
COMPLAINT CONTROL NUMBER: 59-AS-20230627103214
FACILITY NAME:IVY HOMES, INC.FACILITY NUMBER:
455001869
ADMINISTRATOR:CAROL SERGENTFACILITY TYPE:
735
ADDRESS:2729 CAROLEE COURTTELEPHONE:
(530) 223-2663
CITY:REDDINGSTATE: CAZIP CODE:
96002
CAPACITY:4CENSUS: 4DATE:
10/17/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:JULIE SERGENTTIME COMPLETED:
09:40 AM
ALLEGATION(S):
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Facility staff failed to meet the resident’s needs.
Facility staff denied a resident access to the facility.
INVESTIGATION FINDINGS:
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On 10/17/23 Donna Gurriere, Licensing Program Analyst (LPA) arrived at the facility unannounced to deliver final findings regarding a complaint that was received on 06/27/23. LPA Gurriere met with Julie Sergent, Administrator and explained the purpose of the visit.

Facility staff failed to meet the resident’s needs.

During the interview process, the administrator, four staff persons and the regional center supervisor were interviewed. The resident (Resident 1) was not interviewed, as she has since moved from the facility. Documents were received and reviewed to include the resident’s Physician Report, Individual Program Plan (IPP), Appraisal and Needs Services Plan, Progress Report, Medication Administration Record (MARs) and the daily behavioral log.

continued
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Donna Gurriere
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2023
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 2
Control Number 59-AS-20230627103214
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: IVY HOMES, INC.
FACILITY NUMBER: 455001869
VISIT DATE: 10/17/2023
NARRATIVE
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continued

During the investigation, it was reported by all staff that the resident was difficult to manage with numerous behaviors to deal with. Some of the behaviors included being a threat to the public, neighborhood and local businesses, constant elopement, the resident contacting law enforcement to take her to the hospital, creating havoc for other residents and staff, being disruptive and blaring her music with loud singing during the nighttime when other residents were sleeping. Staff reported that they did everything in their power to manage the resident, including driving around at nighttime to look for her when she eloped.

The regional center supervisor reported that after a lengthy time of looking for a replacement facility they finally found one for the resident. The supervisor stated that the resident currently has a two to one staff ratio with the resident to watch her, and to deal with her numerous behaviors. The regional center supervisor advised that the resident is doing well.

Due to the information above, CCL finds the allegations to be Unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Facility staff denied a resident access to the facility.

During the investigation, it was reported by all staff that the resident was difficult to manage with numerous behaviors to deal with, which included her elopements. Staff advised that the facility door was always kept locked to keep strangers from coming into the facility; however, the resident was never “locked” out of the facility. All staff persons reported that the resident knew that she was to ring the “Ring” doorbell and that the staff would let her in.

Due to the information above, CCL finds the allegations to be Unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Donna Gurriere
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2