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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 315920222
Report Date: 02/25/2025
Date Signed: 02/25/2025 11:17:04 AM

Substantiated


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
02/06/2025 and conducted by Evaluator Kevin Mknelly
COMPLAINT CONTROL NUMBER: 59-AS-20250206153154
FACILITY NAME:IVY AT BLUE OAKS, THEFACILITY NUMBER:
315920222
ADMINISTRATOR:DOYLE, ANGELIQUEFACILITY TYPE:
740
ADDRESS:275 ROSEVILLE PARKWAYTELEPHONE:
(916) 432-2878
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY:157CENSUS: 64DATE:
02/25/2025
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Cheryl StevensonTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Staff are not following refund conditions
INVESTIGATION FINDINGS:
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On February 25, 2025, Licensing Program Analyst (LPA) Kevin Mknelly spoke with acting administrator , Cheryl Stevenson, to deliver complaint findings for the above allegation.

LPA reviewed resident records, facility records and conducted interviews.
LPA finds that the allegations cited above are substantiated.

The complaint alleged that R1 paid a pre-admissions fee in July 2024, to reserve a room at the facility. R1 stated the licensee was not yet admitting residents at the time. R1 stated they changed their mind about moving in and went to the facility to let them know on October 7, 2024. R1 stated she spoke to the admissions coordinator.
R1 stated they sent a letter on 10/24/24 stating they would not be moving in and requested a refund of fees paid to date.

Report continued
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025
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
Control Number 59-AS-20250206153154
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 AT BLUE OAKS, THE
FACILITY NUMBER: 315920222
VISIT DATE: 02/25/2025
NARRATIVE
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LPA conducted an investigation visit on February 11, 2025. LPA spoke with Executive Director, Cheryl Stevenson, and the business manager.
LPA reviewed records for R1’s agreement and attempts of the licensee to issue a refund.

LPA found that the personnel with whom R1 interacted July to November 2024 no longer work at the facility as they were directing the opening of the facility. Furthermore, a refund check was written to and mailed to an incorrect person, in November 2024, with the same last name but different first name that R1. The mailing address for the check was also for a person other that R1. This showed that a clerical error occurred which resulted in R1 not receiving a refund within 15 days of R1’s notice to not enter the facility.

LPA has verified that the issue was resolved with both the licensee and resident verifying that the amount due to R1 has now been repaid as of 2/14/25.

As a result of this investigation, LPA finds allegation to be (S) Substantiated - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The following deficiencies were cited on 9099-D, per Title 22 Regulations, Division 6. in care. (B) This poses a potential personal rights violation, to R1.

Report reviewed with Cheryl Stevenson . Copy of this report and appeal rights provided
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 59-AS-20250206153154
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 AT BLUE OAKS, THE
FACILITY NUMBER: 315920222
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/25/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/26/2025
Section Cited
CCR
87507(g)(5)(E)
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Admission Agreements (g) Admission agreements shall specify the following: (5)Refund conditions. (E) Preadmission fees shall be refunded according to the following conditions: A 100 percent refund of a preadmission fee shall be provided to an applicant or the applicant’s
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LPA has verified that R1 has received their reimbursement during the course of this investigation.
Therefore the plan of correction is cleared by this visit.
No further action required at this time.
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 representative if: a. The applicant decides not to enter the facility prior to the facility completing a preadmission appraisal ... This requirement was not met based on records and statements. This posed a potential risk to R1's personal rights.
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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.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025
LIC9099 (FAS) - (06/04)
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