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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455001869
Report Date: 12/05/2024
Date Signed: 12/10/2024 09:12:51 AM

Document Has Been Signed on 12/10/2024 09:12 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:IVY HOMES, INC.FACILITY NUMBER:
455001869
ADMINISTRATOR/
DIRECTOR:		CAROL SERGENTFACILITY TYPE:
735
ADDRESS:2729 CAROLEE COURTTELEPHONE:
(530) 223-2663
CITY:REDDINGSTATE: CAZIP CODE:
96002
CAPACITY: 4CENSUS: 4DATE:
12/05/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Carol & Larry & Julie SergentTIME VISIT/
INSPECTION COMPLETED:
09:35 AM
NARRATIVE
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On 12/05/2024 at 9:00AM, an office meeting was conducted virtually via Microsoft Teams Meeting. The purpose of this office meeting is to discuss an incident that occurred regarding a facility fire. Present in the meeting is Licensing Program Manager (LPM) Anthony Perez, Licensing Program Manager (LPM) Troy Ordonez, Licensing Program Analyst (LPA) Ivan Avila, Administrator Julie Sergent, Licensees Carol and Larry Sergent.

The office meeting process was explained during this meeting.

Topics discussed at the meeting include, but are not limited to:

· Clients residing at licensee’s personal home

· Health and Safety of clients

· Explanation of the Department’s liability concerns.

· Assisting the relocation of clients to ensure a smooth transition

· A relocation license and or approval will take too long

· Coordinating with Far Northern Regional Center for the relocation of clients

LPA will follow-up with Administrator.

Exit interview conducted. Office meeting concluded and a copy of report will be emailed. Facility Representative Signature is expected to be signed and returned to LPA by close of business, 12/05/2024.

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Ivan Avila
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2024
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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