486803653-1-21-2026-21-AS-BMOS-DQRRHE-20260128120210

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803653
Report Date: 01/21/2026
Date Signed: 01/21/2026 03:31:07 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/03/2025 and conducted by Evaluator Star Stevenson

COMPLAINT CONTROL NUMBER: 21-AS-20251203152056

FACILITY NAME:	IVY PARK AT ROCKVILLE		FACILITY NUMBER:	486803653
ADMINISTRATOR:	TEDRA GODFREY		FACILITY TYPE:	740
ADDRESS:	4625 MANGELS BLVD		TELEPHONE:	(707) 356-2229
CITY:	FAIRFIELD	STATE: CA	ZIP CODE:	94534
CAPACITY:	199	CENSUS: 137	DATE:	01/21/2026
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	Executive Director Tedra Godfrey		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff do not allow the residents to choose their own pharmacy

INVESTIGATION FINDINGS:

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At approximately 2:15 PM, Licensing Program Analyst (LPA) Stevenson arrived unannounced to deliver findings for this complaint Investigation regarding the above allegation and met with Executive Director Tetra Godfrey.

On 12/03/2025 Community Care Licensing (CCL) received a complaint alleging that staff at Ivy Park at Rockville do not allow residents to choose their own pharmacy, with reporting party indicating receipt of a letter in late October 2025 stating that, as of February 1st, 2026 all residents would be required to have their medicines blister packed by Consonus Pharmacy and would be required to incur an increased cost to have “non-community pharmacy” (ie. Kaiser) medicines blister packed.

A phone interview with S2 of the Oakmont Management Group overseeing Ivy Park at Rockville on 12/09/2025 indicates the goal of blister packing at the Ivy Park at Rockville community is to provide uniform medicine management to minimize mistakes and maximize patient safety while making it “as little of a net cost to residents as possible”
Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Star Stevenson
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026

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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Control Number 21-AS-20251203152056

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: IVY PARK AT ROCKVILLE	FACILITY NUMBER: 486803653
	VISIT DATE: 01/21/2026

NARRATIVE

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Continued from LIC9099
Review of a Service Plan received for R1 developed on 01/01/2025 indicates under the “Medicine Management” section that R1 receives full assistance with medicine management including, getting, “assistance with 10+ centrally stored medications” and “coordination with non-house pharmacy”, the service plan also indicates that R1 gets most of their medications filled through Kaiser, while R1’s family provides all over-the-counter (OTC) medicines.

A follow up phone interview with S2 of the Oakmont Management Group overseeing Ivy Park at Rockville on 12/22/2025 and a follow up letter from S2 received 12/23/2025 indicates that responsible parties can provide medicines and pay themselves for prescription medicines to be re-packaged with Consonus Pharmacy or if a responsible party chooses not to sign a contract with Consonus Pharmacy for re-packaging, the community may cover the repackaging fees and pass the cost onto the residents through a monthly invoice.

A blank Care Assessment Form provided to this LPA by S1 at Ivy Park at Rockville on 12/23/2025 indicates that as of 10/28/2025 the Executive Director (ED) will have discretion when assigning Pharmacy Care Points and costs for Kaiser and VA residents”

Finally, a review of an Ivy Park at Rockville Resident and Service Agreement Section II (B)(4) provided to this LPA on 12/09/2025 indicates, “Fee Increase. Ivy may change any fees for General Services, Care Services, or additional items…upon (90) days written notice” as well as a Services section I(C)(13) under Additional Items and Services, “Ivy will make available…additional items and services at an extra charge, to be billed...on a monthly basis…any additional items or services that Ivy offers in the future”

Because residents can continue with the pharmacy of their choice, and because the management at Ivy Park at Rockville has provided the necessary 90 days’ notice for a service fee increase, this allegation is unsubstantiated

A finding that the complaint allegation is Unsubstantiated means that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.
Exit interview conducted. Copy of report discussed and provided to Executive Director Tedra Godfrey.
Signature on form confirms receipt of documents.

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Star Stevenson
LICENSING EVALUATOR SIGNATURE:	DATE: 01/21/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026

LIC9099 (FAS) - (06/04)

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