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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006222
Report Date: 01/16/2025
Date Signed: 01/16/2025 09:23:55 AM

Document Has Been Signed on 01/16/2025 09:23 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:IVY AT WELLINGTON, THEFACILITY NUMBER:
306006222
ADMINISTRATOR/
DIRECTOR:		VADNAIS, GERRYFACILITY TYPE:
740
ADDRESS:24903 MOULTON PARKWAYTELEPHONE:
(949) 458-2311
CITY:LAGUNA HILLSSTATE: CAZIP CODE:
92653
CAPACITY: 305CENSUS: 117DATE:
01/16/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:15 AM
MET WITH:Marites Meneses, Health Services Director TIME VISIT/
INSPECTION COMPLETED:
09:30 AM
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On this day Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to deliver amended report.

Due to technical difficulties LPA delivered findings to facility on 01/09/2025.
LPA Mendivil discussed amended report with Maritese Meneses, Heath Services Director and Gerry Vadnais, Executive Director.

An exit interview was conducted with facility staff and a copy of this report, and amended report of findings delivered on 01/09/2025 were provided at exit.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE: DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/16/2025
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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