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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604455
Report Date: 05/15/2024
Date Signed: 05/15/2024 02:12:17 PM


Document Has Been Signed on 05/15/2024 02:12 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:IVY PARK AT OTAY RANCHFACILITY NUMBER:
374604455
ADMINISTRATOR:CALAIS ANGUIANOFACILITY TYPE:
740
ADDRESS:1290 SANTA ROSE DRIVETELEPHONE:
(619) 779-7400
CITY:CHULA VISTASTATE: CAZIP CODE:
91913
CAPACITY:137CENSUS: 107DATE:
05/15/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Business Office Manager Silvia GarciaTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Juliana Barfield conducted an unannounced case-management visit. LPA met with Business Office Manager Silvia Garcia, and discussed the purpose of the visit.

This visit was initiated due to a self-reported incident involving possible abuse of Resident #1 (R1).

During today's visit, LPA toured the facility with Maintenance Director Justin Brown, observed residents in care, and obtained copies from Silvia Garcia of staff and R1's records . No immediate health and/or safety concerns were observed during the visit.

No deficiencies were cited during today's visit. An exit interview was conducted with Silvia Garcia, and a copy of this report along with Licensee/Appeal Rights (LIC9058 01/16) were provided to them at the conclusion of the visit.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Juliana BarfieldTELEPHONE: (619) 994-7269
LICENSING EVALUATOR SIGNATURE:
DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/15/2024
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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