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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 275202849
Report Date: 07/27/2022
Date Signed: 07/27/2022 10:24:42 AM


Document Has Been Signed on 07/27/2022 10:24 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 SALINASFACILITY NUMBER:
275202849
ADMINISTRATOR:POST, SARAFACILITY TYPE:
740
ADDRESS:1320 PADRE DRIVETELEPHONE:
(831) 754-5532
CITY:SALINASSTATE: CAZIP CODE:
93901
CAPACITY:185CENSUS: 170DATE:
07/27/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:11 AM
MET WITH:Memory Care Director Cynthia HuertaTIME COMPLETED:
10:30 AM
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Licensing Program Analyst Shawna Doucette arrived at the facility unannounced to deliver PPE to the facility. LPA met with Memory Care Director Cynthia Huerta.

Facility received 50 gowns and 600 surgical masks.


An exit interview with the and a copy of this report was provided.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Shawna DoucetteTELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:
DATE: 07/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2022
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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