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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209257
Report Date: 09/12/2023
Date Signed: 09/12/2023 03:46:14 PM


Document Has Been Signed on 09/12/2023 03:46 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:IVY PARK AT SEVEN OAKSFACILITY NUMBER:
157209257
ADMINISTRATOR:BRADLEY, PAMELAFACILITY TYPE:
740
ADDRESS:4301 AND 4225 BUENA VISTA ROADTELEPHONE:
(661) 837-1337
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY:164CENSUS: 89DATE:
09/12/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Pamela Bradley, Administrator/ Executive DirectorTIME COMPLETED:
04:00 PM
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On 09/12/23, Licensing Program Analyst (LPA) M. Yang conducted case management visit to the facility. LPA introduce self, stated the purpose of the visit, and met with Administrator/ Executive Director Pamela Bradley.

The purpose of today's visit is to follow up on information that was received at the Community Care Regional office regarding facility did not provide resident 1 (R1) refund for community fee and refund fee.

Copies of records were reviewed and received. Interview were conducted. Based on records reviewed and interview conducted, R1 reside at the facility for over 90 days after the community fee refund contract prorated basis. No refund issued to the resident; the resident has a remaining balance for services provided for the companion care.

No deficiencies issued.

An exit interview was conducted. A copy of this report was provided to Administrator/ Executive Director, whose signature confirms receipt of this report.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -65-7912
LICENSING EVALUATOR NAME: Mai YangTELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:
DATE: 09/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/12/2023
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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