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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002981
Report Date: 11/02/2023
Date Signed: 11/02/2023 10:17:42 AM

Document Has Been Signed on 11/02/2023 10:17 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:IPS DAY PROGRAM #2FACILITY NUMBER:
455002981
ADMINISTRATOR:GOMEZ-ZUMKEHR, AMANDAFACILITY TYPE:
775
ADDRESS:2580 S BONNYVIEW RD #CTELEPHONE:
(530) 221-9025
CITY:REDDINGSTATE: CAZIP CODE:
96001
CAPACITY: 35CENSUS: 32DATE:
11/02/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Adminstrator Amanda ZumkehrTIME COMPLETED:
10:30 AM
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On 11/2/2023, Licensing Program Analyst (LPA) Jaynae Boyles, arrived at the facility unannounced to conduct a 1-Year Required Annual Inspection. LPA met with Facility Administrator,Amanda Zumkehr and explained the purpose of the visit.

LPA Boyles and Administrator toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, 10 classrooms and common restrooms.

LPA observed the facility to be clean, in good repair and odor-free. LPA observed each bathroom to have necessary paper towels and trash can with lids. Hot water measured above the regulation requirement and a technical violation issued to the facility.

LPA observed four (4) fire extinguishers, fire detectors, and carbon monoxide detectors. The fire system was last serviced in September of 2023.

In the areas toured no immediate health, safety, or personal rights violations were observed.

LPA reviewed a total of five (5) residents' files and three (3) staff files which all contained the required documentation.

Several topics were discussed.

No deficiencies are being cited as a result of today’s inspection.

Exit interview conducted and copy of report left at the facility.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Jaynae Boyles
LICENSING EVALUATOR SIGNATURE: DATE: 11/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/02/2023
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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