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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701234
Report Date: 05/06/2026
Date Signed: 05/08/2026 09:05:04 AM

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
04/28/2026 and conducted by Evaluator Avelina Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20260428081320
FACILITY NAME:IVY RIDGE ASSISTED LIVINGFACILITY NUMBER:
342701234
ADMINISTRATOR:LEZEL BELLOFACILITY TYPE:
740
ADDRESS:2030 23RD STTELEPHONE:
(916) 600-3309
CITY:SACRAMENTOSTATE: CAZIP CODE:
95818
CAPACITY:36CENSUS: 36DATE:
05/06/2026
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Lezel BelloTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff does not ensure facility is maintained in good repair, clean safe and/or sanitary.
Staff does not ensure call signal system is in good repair.
INVESTIGATION FINDINGS:
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On May 06, 2026, at 11:45 AM, Licensing Program Analyst (LPA) Avelina Martinez conducted an unannounced facility visit to initiate a complaint investigation and deliver complaint finding for the above allegations. LPA Martinez met with Lezel Bello and explained the purpose of today’s visit.

During today's facility visit, LPA Martinez conducted a tour of the facility, conducted interviews, and tested call signal system. During today's facility tour, LPA Martinez observed the following items at the resident courtyard: Box spring; multiple plastic garbage cans that are not in use; shower chair, walker, rake, broke plastic storage box, Yellow mop bucket filled with dirty water and dirty mop, a gray and red mop bucket, chicken wire. Additionally, LPA Martinez observed an unattended yellow mop bucket located in a resident hall way.

Continued...

Substantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Avelina Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2026
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 4
Control Number 27-AS-20260428081320
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: 05/06/2026
NARRATIVE
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 LPA Martinez also observed an outdoor sink that was not cleaned and had rust spots. The sink basin was filled with miscellaneous unsanitary decor.(plastic owl, green frog statue, ceramic cat, ceramic pots, and a squirrel). LPA Martinez also observed a dead fly on resident R1's (R1) bedroom wall. During an interview, LPA Martinez was informed that the dead fly was on the wall for over a week. In addition, R1's bed was up against the wall that had the dead fly.

LPA Martinez also tested call signal pull cords in resident bathroom three and resident bathroom four. LPA Martinez pulled the signal pull cord in bathroom three at 12:31 PM, and waited for ten minutes. Medication Technician 1 (MT1) walked by the bathroom and administered medication to resident 2 (R2). After MT1 administered the medication to R2, they walked away to administer medication to R1. LPA Martinez walked to bathroom 4 and pulled the signal cord around 12:45 PM. While LPA Martinez was waiting for staff to respond, they asked MT1 if they were aware that the bathroom call signal cord was pulled. MT1 reported they did not have a pager, so they were not aware that signal pull cord was pulled. MT1 used their walkie talkie to ask staff to locate the pager. Staff 2(S2) had the pager. However, the pager did not alert S2 that the bathroom signal pull cord was pulled. The facility maintenance employee was called to test bathroom 4 signal pull cord, and it was learned it was not working properly. The facility maintenance employee replaced the battery and cleaned the signal pull cord device. After installing a new battery and being cleaned the signal pull cord device began working properly. LPA Martinez learned that the signal pull cord device batteries are changed twice a year, and the signal pull cord devices are not inspected or tested throughout the year.

Based on today's complaint investigation, it was learned that staff are not responding to call system alerts in a timely manner due to faulty signal pull cords. Based on observation and inspection of the facility, it was determined the facility is not maintained in good repair, clean safe and/or sanitary.

As a result of this investigation, the Department finds these allegations to be 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 page, per Title 22 Regulations. An exit interview was conducted, and a copy of this LIC 9099 report, LIC 9099-D page, and LIC appeal rights documents were provided to the facility.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Avelina Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 27-AS-20260428081320
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: 05/06/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/20/2026
Section Cited
CCR
87303(a)
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87303(a) Maintenance and Operation: the facility shall be clean, safe, sanitary and in good repair at all times. This requirement was not met as evidence by: Based on observation and interviews, the Licensee did not the facility was kept clean, safe, and sanitary.
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Facility staff agrees to conduct a maintenance and operation in service training for staff by POC date 05/20/2026. Facility staff agrees to email in service training documents to LPA Martinez by 05/20/2025 by 5:00PM.
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This posed a potential health and safety risk to residents in care.
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Type B
05/20/2026
Section Cited
CCR
87303(i)(1)(B)
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87303(i)(1)(B) Maintenance and Operation: Facilities shall have signal systems which shall meet the following criteria: Transmit a visual and/or auditory signal to a central staffed location or produce an auditory signal at the living unit loud enough to summon staff.
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Facility staff agrees to conduct a maintenance and operation in service training for staff by POC date 05/20/2026. Facility staff agrees to email in service training documents to LPA Martinez by 05/20/2025 by 5:00PM.
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this requirement was not met as evidence by:Based on inspection, observation, interviews, the Licensee did not ensure signal system was in good repair and that it was transmitting an auditory signal to care staff. This posed a potential health and safety risk to residents in care.
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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: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Avelina Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4