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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306006203
Report Date:
02/19/2025
Date Signed:
02/19/2025 05:25:48 PM
Document Has Been Signed on
02/19/2025 05:25 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 SAN JUAN CAPISTRANO
FACILITY NUMBER:
306006203
ADMINISTRATOR/
DIRECTOR:
DAVID ALVARADO
FACILITY TYPE:
740
ADDRESS:
32200 DEL OBISPO STREET
TELEPHONE:
(949) 496-8802
CITY:
SAN JUAN CAPISTRANO
STATE:
CA
ZIP CODE:
92675
CAPACITY:
120
CENSUS:
78
DATE:
02/19/2025
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
05:10 PM
MET WITH:
Veronika Labastida
TIME VISIT/
INSPECTION COMPLETED:
05:33 PM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to follow up on a report received by the Agency. LPA met with Health Services Director and explained the reason for the visit. The Health Services Director reported they have complied with the instructions from Orange County Health Care Agency and will send a copy of the information sent to the Agency. (CCL). Health Services Director report there are no issues to report and the facility is fully staff and has an ample supply of PPE. LPA informed the Health Care Services Director to continue to report any incidents as required by regulation. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.
SUPERVISORS NAME
:
Sheila Santos
LICENSING EVALUATOR NAME
:
Joseph Alejandre
LICENSING EVALUATOR SIGNATURE
:
DATE:
02/19/2025
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
02/19/2025
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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