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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157209257
Report Date: 11/06/2024
Date Signed: 11/06/2024 11:34:34 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/24/2024 and conducted by Evaluator Mai Yang
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20241024161314
FACILITY NAME:IVY PARK AT SEVEN OAKSFACILITY NUMBER:
157209257
ADMINISTRATOR:BRADLEY, PAMELAFACILITY TYPE:
740
ADDRESS:4301 AND 4225 BUENA VISTA ROADTELEPHONE:
(661) 837-1337
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY:164CENSUS: 103DATE:
11/06/2024
UNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Annette Eggleston, Health Service Director TIME COMPLETED:
11:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not follow resident's Physician Orders for Life-Sustaining Treatment (POLST)
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 11/06/24, Licensing Program Analyst (LPA) M. Yang arrived uannounced to deliver findings on the above allegation. LPA introduce self, stated the purpose of the visit, and met with Health Service Director Annette Eggleston, who stated Administrator Pamela Bradley is unavailable to attend meeting.

The department conducted interviews and received copies of records. The facility followed the resident request which was signed and selected by R1, POLST and to attempt CPR unless doctor stated otherwise. Therefore, the allegation above is founded to be UNFOUNDED, meaning they were false, could not have happened, and/or are without reasonable basis. We have therefore dismissed the complaint. An exit interview was conducted. A copy of this report was provided to Health Service Director, whose signature confirms received of this report.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2024
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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