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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002731
Report Date: 12/12/2024
Date Signed: 12/12/2024 02:09:05 PM

Document Has Been Signed on 12/12/2024 02:09 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:IPS- VINSON DRIVEFACILITY NUMBER:
455002731
ADMINISTRATOR/
DIRECTOR:		KNIGHT, JOSHUAFACILITY TYPE:
735
ADDRESS:1786 VINSON DRIVETELEPHONE:
(530) 605-3755
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY: 4CENSUS: 4DATE:
12/12/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Residential Care Coordinator, Amanda ZumkehrTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On December 12, 2024 at approximately 01:30 PM, Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at IPS-Vinson for the purpose of conducting a Case Management-Incident Inspection. LPA was granted access into the facility. LPA met with Residential Care Coordinator, Amanda Zumkehr.

During the Case Management-Incident inspection, LPA and Administrator reviewed the incident reports that was submitted by the facility to Community Care Licensing Division. LPA advised that there have been a medication mismanagement identified in the Incident Report that was forwarded to Community Care Licensing Division on November 2, 2024 (See LIC 9102-Technical Violation). LPA educated the Residential Care Coordinator regarding the importance of ensuring that ALL medications are dispensed as outlined in Title 22 Regulations. LPA advised that if another incident of this similar nature is repeated, a citation will be issued.

No deficiencies were cited during today's Case Management-Incident Inspection. Exit interview was conducted, and a copy of this report was signed and given to the Residential Care Coordinator.
SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Farhaan Sarangi
LICENSING EVALUATOR SIGNATURE: DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/12/2024
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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