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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006402
Report Date: 07/08/2024
Date Signed: 07/08/2024 02:52:09 PM


Document Has Been Signed on 07/08/2024 02:52 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:
306006402
ADMINISTRATOR:TURGEON, JENNIFERFACILITY TYPE:
740
ADDRESS:3850 AND 3840 LAMPSON AVETELEPHONE:
(562) 594-5788
CITY:SEAL BEACHSTATE: CAZIP CODE:
90740
CAPACITY:261CENSUS: 169DATE:
07/08/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Jennifer TurgeonTIME COMPLETED:
03:05 PM
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Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced case management visit to follow up on a Death Report sent to the Regional Office dated July 3, 2024.

During the visit, LPA Haley conducted interviews with staff and collected relevant documents.

As a result of today’s case management visit and the information gathered through staff interviews, no deficiencies will be cited.

An exit interview was conducted and a copy of this report was provided to Executive Director Turgeon.

SUPERVISOR'S NAME: Lourdes MontoyaTELEPHONE: (714) 703-2870
LICENSING EVALUATOR NAME: Jerome HaleyTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 07/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/08/2024
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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