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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 315920222
Report Date: 09/23/2025
Date Signed: 09/23/2025 04:12:25 PM

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
07/16/2025 and conducted by Evaluator Kevin Mknelly
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20250716160452
FACILITY NAME:IVY AT BLUE OAKS, THEFACILITY NUMBER:
315920222
ADMINISTRATOR:SWEARINGEN, MICHELLEFACILITY TYPE:
740
ADDRESS:275 ROSEVILLE PARKWAYTELEPHONE:
(916) 432-2878
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY:157CENSUS: DATE:
09/23/2025
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Michelle SwearingenTIME COMPLETED:
11:30 PM
ALLEGATION(S):
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Facility staff did not allow resident to attend activities of choice.
INVESTIGATION FINDINGS:
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On 9/23/25, Licensing Program Analyst (LPA) Kevin Mknelly spoke to Executive Director (ED), Michelle Swearingen, to deliver complaint findings for the above allegation.

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

Documents and interviews found that R1 moved into the facility, with their spouse, into assisted living. At the time of the admission, R1 was known to have a cognitive disorder diagnosis with behavioral disturbance.
In February, R1, spouse was hospitalized. While spouse, who is the power of attorney for R1, was hospitalized, a decision was made with Administrator and another family member, to move R1 to memory care for safety and supervision of R1.
Upon R1’s spouse return to the facility, R1 and spouse wished to interact within the facility and on outings.
Report continued
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2025
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 4
Control Number 59-AS-20250716160452
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: 09/23/2025
NARRATIVE
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R1 was restricted at times to join their spouse for meals in assisted living and to participate in outings provided by the facility.

During the course of this investigation, R1 and their spouse have since been allowed to have increased freedom of movement and safety measures have been put in place.
Though improved, at the time of the complaint, R1’s personal right to attend activities of their choice.

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. (B) This poses a potential Health and Safety risk, or personal rights violation, to clients/residents in care.

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

DATE: 09/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 59-AS-20250716160452
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: 09/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/21/2025
Section Cited
CCR
87468.2(a)(6)
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Additional Personal Rights of Residents in Privately Operated Facilities (a) (6) To make choices concerning their daily lives in the facility. This requirement was not met.
Based on records and statements, for a time, R1, was not allowed to make
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During the course of this investigation a plan has been developed and adopted to reinstate R1's rights to move within and out of the facility under the supervision of others.

POC cleared by visit
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 choices regarding their daily lives at the facility. This posed a potential violation of their 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: 09/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
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
07/16/2025 and conducted by Evaluator Kevin Mknelly
COMPLAINT CONTROL NUMBER: 59-AS-20250716160452

FACILITY NAME:IVY AT BLUE OAKS, THEFACILITY NUMBER:
315920222
ADMINISTRATOR:SWEARINGEN, MICHELLEFACILITY TYPE:
740
ADDRESS:275 ROSEVILLE PARKWAYTELEPHONE:
(916) 432-2878
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY:157CENSUS: DATE:
09/23/2025
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Michelle SwearingenTIME COMPLETED:
11:30 PM
ALLEGATION(S):
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Facility staff did not answer communications from family members of resident appropriately.
INVESTIGATION FINDINGS:
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On 9/23/25, Licensing Program Analyst (LPA) Kevin Mknelly conducted an unannounced complaint investigation visit to deliver the findings for the above allegations and met withED/ administrator.

LPA conducted records review and extensive interviews.
LPA is unable to find and or meet the preponderance, per policy.
Records and statements found many communications between R1’s power of attorney and facility staff.
While it is undetermined if the conversations reviewed represented the totality of all communications attempted, it appeared that questions raised by R1’s representative and family were responded to.

As a result of this investigation, LPA finds allegation to be (US)Unsubstantiated - A finding that the complaint is Unsubstantiated means 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.

Exit interview with administrator.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 4