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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701363
Report Date: 10/09/2025
Date Signed: 10/09/2025 01:28:36 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 10/09/2025 01:28 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:IVY PARK AT SACRAMENTOFACILITY NUMBER:
342701363
ADMINISTRATOR/
DIRECTOR:		WEININGER, SARAFACILITY TYPE:
740
ADDRESS:345 MUNROE STREETTELEPHONE:
(916) 486-0200
CITY:SACRAMENTOSTATE: CAZIP CODE:
95825
CAPACITY: 70CENSUS: 59DATE:
10/09/2025
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Sara Weininger, Executive DirectorTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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On 10/09/25, Licensing Program Analyst (LPA) Kimberly Viarella made an unannounced visit to this facility to continue the annual inspection that was initiated on 10/01/25. LPA identified herself upon arrival, stated the purpose of the visit and asked to meet with the Designated Facility Administrator / Executive Director. LPA met with Sara Weininger and a brief interview followed.

LPA observed 3 residents finishing up breakfast in the dining room of assisted living and 2 servers cleaning and setting up for lunch. LPA conducted an inspection of the kitchen on 10/01/25. The kitchen was inaccessible to residents in care. LPA observed that kitchen staff were wearing appropriate clothing, gloves, and long hair was secured appropriately at the time of the inspection. LPA inspected inventory of food and found it to be sufficient for 7-day perishable and 2-day non-perishable.  All items were stored and dated appropriately and the fire extinguishers were last inspected on by Fire and Power Protection Co. on 01/29/25.

The ED and LPA proceeded to visit 2 resident rooms in assisted living. All had the required furniture, furnishings and lighting to be in compliance at the time of this inspection.  LPA inspected the bathrooms and observed hand soap, towels and trash cans along with grab bars and non-slip/skid surfaces in the showers.  LPA measure the hot water in room 226 to ensure it was between the required 105 - 120 degrees Fahrenheit.  The hot water measured 111.9 and was in compliance at the time of this inspection. LPA activated the call alert/pendant in room 224.  Staff responded in 2.4 minutes.

LPA and ED inspected the Medication Room in Assisted Living.  LPA reviewed the administration, storage and destruction procedures with the medication tech on duty. LPA also inspected the first aid kit to ensure it had all the required elements.
NAME OF LICENSING PROGRAM MANAGER: Stephen Richardson
NAME OF LICENSING PROGRAM ANALYST: Kimberly Viarella
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/09/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: IVY PARK AT SACRAMENTO
FACILITY NUMBER: 342701363
VISIT DATE: 10/09/2025
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LPA observed 7 residents in assisted living participating in a morning fitness class in an activity room led by a staff member. 

LPA and ED toured memory care community where the LPA then inspected their Medication Room and reviewed the centrally stored medication logs. LPA inspected the medication cart and reviewed a sample of resident medications contained in the locked unit. LPA spoke to one resident who was well-groomed and sitting in main corridor "waiting for a ride." LPA also observed 4 residents in the dining area supervised by staff.
 
The following materials were posted in the facility: "If You See Something, Say Something" and Ombudsman contact information posters, Resident Rights, grievance policy, calendar of activities, facility menus, and facility license.

The ED and the LPA inspected the exterior of the facility. All screens and gutters were in good repair at the time of this inspection. There was a fenced in / courtyard area in memory care and a partially walled in area in assisted living; both had shaded areas and furniture for residents to enjoy. LPA also inspected the locked storage shed that contained the emergency food supply and extra furniture.
 
A file review was conducted by the LPA. The staff roster was reviewed to ensure that all required employees had the appropriate background clearances. All were in compliance at the time of this inspection.

Files were then reviewed for 3 residents. All were in compliance at the time of this inspection. LPA and ED discussed the different format for the two service plans utilized in different files and LPA provided technical assistance regarding information that should be included in each. The ED explained how the staff utilize workflow /assignment sheets to provide the necessary information that the electronic plans do not.

According to the California Code of Regulations, Title 22, no deficiencies were observed or cited during today's inspection. A copy of this report was provided and an exit interview was conducted with Sara Weininger.
NAME OF LICENSING PROGRAM MANAGER: Stephen Richardson
NAME OF LICENSING PROGRAM ANALYST: Kimberly Viarella
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
LIC809 (FAS) - (06/04)
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