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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002981
Report Date: 01/31/2024
Date Signed: 01/31/2024 11:47:15 AM

Document Has Been Signed on 01/31/2024 11:47 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: 35DATE:
01/31/2024
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Feather VcelikTIME COMPLETED:
12:10 PM
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On 01/31/2024 Licensing Program Analyst (LPA) Ivan Avila arrived at the facility for a collateral visit and met with Feather Vcelik and explained the purpose of the visit. This is in relation to a complaint at another facility and not a complaint against the day program. Staff was interviewed during today's visit.

An exit interview was conducted and this report was provided to the day program.

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Ivan Avila
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2024
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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