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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701234
Report Date: 09/11/2024
Date Signed: 09/11/2024 10:54:07 AM


Document Has Been Signed on 09/11/2024 10:54 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:IVY RIDGE ASSISTED LIVINGFACILITY NUMBER:
342701234
ADMINISTRATOR:HONG TRINH (ZOE)FACILITY TYPE:
740
ADDRESS:2030 23RD STTELEPHONE:
(916) 600-3309
CITY:SACRAMENTOSTATE: CAZIP CODE:
95818
CAPACITY:36CENSUS: 0DATE:
09/11/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Pak Wu and Hong TrinhTIME COMPLETED:
11:00 AM
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A in conference was conducted today on September 11, 2024, in the Sacramento South Regional Office. The purpose of this meeting is to discuss changes that the licensee wants to conduct at Ivy Ridge. Present in the meeting is Licensing Program Manager (LPM) Czarrina Camilon-Lee, Licensing Program Analysts (LPA) Pang Lee, Licensee Pak Wu and Administrator Hong Trinh.

Issues discussed during the meeting were:
· Expand the building census from 36 to 49.
· How many residents are non-ambulatory/fire clearance.
· Exhaust fan will be replaced in restroom in the Terrace building.
· Install AC unit for Wall building.
· Install solar panel in the Wall Building.
· Licensee interested in connecting the Main Building with the Wall Building and the Terrace Building.
· Install a lift and ramp to the Main Building and connect the ramp to the Terrace.

CCLD advised to Licensee and Administrator:

· Notify the planning department and with the fire department.

· Building permit

· Purposed in writing the changes and what to expand.

· Provide CCLD a breakdown of the phrases of the changes.

· What will the plan be for resident in care to ensure their safety during the expansion.

· Notify building department to get permit.

· Once obtain permit inform CCLD.

An exit interview was conducted, and a copy of this LIC 809 report were provided to Licensee and Administrator.

SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Pang LeeTELEPHONE: (916) 508-9726
LICENSING EVALUATOR SIGNATURE:
DATE: 09/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/11/2024
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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