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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004562
Report Date: 12/22/2023
Date Signed: 12/22/2023 01:31:21 PM


Document Has Been Signed on 12/22/2023 01:31 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:IVY PARK AT SEAL BEACHFACILITY NUMBER:
306004562
ADMINISTRATOR:TURGEON, JENNIFERFACILITY TYPE:
740
ADDRESS:3850 & 3840 LAMPSON AVETELEPHONE:
(562) 594-5788
CITY:SEAL BEACHSTATE: CAZIP CODE:
90740
CAPACITY:261CENSUS: 146DATE:
12/22/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Jennifer Turgeon, Executive DirectorTIME COMPLETED:
01:30 PM
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On this day, LIcensing Program Analysts (LPAs) Kevin Saborit-Guasch and Dwayne Mason Jr. made an unannounced visit to the facility for the purpose of following up on a Special Incident Report submitted by the facility to the Orange County Regional Office on December 22, 2023 regarding an incident involving a staff member that happened on the evening of December 20, 2023. LPAs were greeted and granted entry by facility Executive Director Jennifer Turgeon after introducing themselves and stating the reason for the visit.

The Executive Director informed LPAs that the incident had been reported by the facility to the Seal Beach Police Department under case number #2302859 on December 21, 2023 and that law enforcement had been following up on a regular basis with the facility. Two staff interviews were conducted during the visit along with a review of staff records.

LPAs accompanied by Executive Director conducted a tour of the facility's physical plant and made a Health & Safety visit, reviewing the facility's routes of ingress and egress. No health and/or safety concerns were evidenced during the visit. LPAs instructed the Executive Director to update the reported information regarding the incident via an updated form LIC624 whenever relevant.

An exit interview was conducted and a copy of this report was left to a facility representative.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-GuaschTELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:
DATE: 12/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/22/2023
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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