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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347001903
Report Date: 12/19/2022
Date Signed: 12/20/2022 03:53:36 PM


Document Has Been Signed on 12/20/2022 03:53 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:IVY RIDGE ASSISTED LIVINGFACILITY NUMBER:
347001903
ADMINISTRATOR:TRINH, HONGFACILITY TYPE:
740
ADDRESS:2030 23RD STREETTELEPHONE:
(916) 455-8849
CITY:SACRAMENTOSTATE: CAZIP CODE:
95818
CAPACITY:36CENSUS: DATE:
12/19/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Hong Trinh and Pak WuTIME COMPLETED:
12:00 PM
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An Office Meeting was conducted by Sacramento North’s Office on 12/19/22 via Microsoft Teams. Sacramento South Office Regional Manager (RM) Stephenie Doub, Licensing Program Manager (LPM) Czarrina Camilon-Lee and Licensing Program Analyst (LPA) Tung Truong participated in this meeting with the management company (Ivy Ridge Care, Inc.) representatives: Pak Wu and Hong Trinh aka Zoe Zheng regarding concerns with their licensed facility with Sacramento North.

Issues discussed during the meeting were:
- Administrator Qualifications
- Ensuring proof of correction (POC) is submitted timely.
- Ensuring the facility has proper oversight if the administrator is responsible for multiple facilities

Management company Ivy Ridge Care, Inc. was reminded that they need to follow Title 22 requirements above for Ivy Ridge.

At this time, no deficiencies are being cited.

Exit interview was conducted and a copy of this report will be provided to the facility. A copy will be signed and returned to CCLD.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Tung TruongTELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:
DATE: 12/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/19/2022
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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