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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455001728
Report Date: 06/20/2023
Date Signed: 06/20/2023 11:21:52 AM

Document Has Been Signed on 06/20/2023 11:21 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:I.P.S DAY PROGRAMFACILITY NUMBER:
455001728
ADMINISTRATOR:BAUGHMAN, KELLYFACILITY TYPE:
775
ADDRESS:2170 MARKET STREETTELEPHONE:
(530) 244-2352
CITY:REDDINGSTATE: CAZIP CODE:
96001
CAPACITY: 6CENSUS: 4DATE:
06/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Amanda ZumkehrTIME COMPLETED:
11:30 AM
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LPA Hiratsuka, conducted this unannounced annual visit. LPA toured the facility with Patricia Jeantet. Administrator Amanda Zumkehr, arrived during the visit.

This facility has a fire clearance for four ambulatory and two non-ambulatory clients. The main entrance opens to an office and a room with two half-bathrooms on the left. There is a doorway from the front office leading to the main common area. To the left of the main common area is a small activity room that connects to a sun room that connects to a storage room that connects to the kitchen and the kitchen connects to the main common area. There is a basement with a locked doorway to prevent clients from getting in. The backyard has a ramp. The front entrance has a ramp.

Several topics were discussed.

Several items were updated during this visit.

No deficiencies cited.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Kerry Hiratsuka
LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2023
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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