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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209257
Report Date: 01/09/2023
Date Signed: 01/09/2023 11:24:33 AM


Document Has Been Signed on 01/09/2023 11:24 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: 73DATE:
01/09/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Pamela Bradley, Exectuive DirectorTIME COMPLETED:
11:25 AM
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On 01/09/23, Licensing Program Analyst (LPA) M. Yang arrived announced to conduct a follow-up Pre-Licensing inspection/ Component III Inspection. LPA introduced self, stated the purpose of the visit, and met with Pamela Bradley, Executive Director. LPA toured facility with Executive Director and Annette Eggleston, Health Service Director.

LPA observed medications and all sharps removed from residents’ room inaccessible to residents. LPA observed cleaning chemicals stored and locked in shelf.

Component III was conducted during today's follow-up pre-licensing visit.

LPA found that the applicant has met all pre-licensing requirements. LPA will submit documentation to CAB in Sacramento and notify Licensing Program Manager for final review prior to license being issued.

Exit interview conducted. An exit interview was conducted. 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: 01/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2023
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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