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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209257
Report Date: 12/28/2022
Date Signed: 12/29/2022 09:55:17 AM


Document Has Been Signed on 12/29/2022 09:55 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:IVY PARK AT SEVEN OAKSFACILITY NUMBER:
157209257
ADMINISTRATOR:JENKINS, KRYSTALFACILITY TYPE:
740
ADDRESS:4301 AND 4225 BUENA VISTA ROADTELEPHONE:
(661) 837-1337
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY:164CENSUS: 75DATE:
12/28/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Krystal Jenkins, Executive DirectorTIME COMPLETED:
11:45 AM
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On 12/28/22, Licensing Program Analyst (LPA) M. Yang conducted an announced Pre-licensing / Component III Inspection. LPA introduced self, stated the purpose of the visit, and met with Executive Directory Krystal Jenkins.

The facility is a 164 bedroom of which 116 bedrooms is in assisted living and 48 bedrooms is in memory care. Fire clearance is granted by the local Fire Department for 156 non-ambulatory and 8 bedridden for total capacity of 164.

LPA conducted a tour inside and outside of the facility. The following areas were toured and inspected:

1st Floor: Administration offices, Front Lobby, Mail Room, Fitness Center, Laundry Room, Supply Room, Private Dining Room, Dining Area, Medication Room, Kitchen, Lounge room, Activity rooms, and a sample of rooms.

2nd Floor: Hair Salon, Laundry Room, Lounge room, Medication Room, Gym, Theater, Supply room, and a sample of rooms.

Memory Care: Laundry Room, Dining room, and Activity room, and a sample of bedrooms.

LPA observed bathrooms to be functioning properly with grab bars. Bathrooms temperature range from 108.2 to 109.4 degree in Assisted Living and 108.4 to 110.5 degree in Memory Care.

Food supply was checked and appeared to be an adequate supply. Refrigerator temperature maintained at 40-degree F and Freezer temperature maintained at 0-degree F. Emergency exits are posted. A fire extinguisher observed in every hallway and observed with service date of 10/10/22. First Aid kit located at facility front desk, kitchen and medication rooms with required items. Medications were kept locked and inaccessible to residents in care in medication room. A sample of resident records were reviewed. LPA observed resident Admission Agreements, Pre-Appraisal, and Physician Reports. A sample of staff records were reviewed to have a criminal record clearance and good health screening.

SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Mai YangTELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:
DATE: 12/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/28/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: IVY PARK AT SEVEN OAKS
FACILITY NUMBER: 157209257
VISIT DATE: 12/28/2022
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The following will need to be brought into compliance:

1. All bathroom shower need to a non-skid mat or strip.

2. All medications shall be stored and locked inaccessible to residents in care.

3. All cleaning chemicals shall be stored and locked inaccessible to residents in care.

4. All sharps shall be stored and locked inaccessible to residents in care.

Licensee to contact LPA within 30 days to conduct a follow-up inspection. An exit interview was conducted, and list of corrections were discussed. A copy of this report was provided to Executive Director.

SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Mai YangTELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:

DATE: 12/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2022
LIC809 (FAS) - (06/04)
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