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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455002981
Report Date: 03/19/2024
Date Signed: 03/19/2024 01:26:17 PM

Document Has Been Signed on 03/19/2024 01:26 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 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: 36DATE:
03/19/2024
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Feather VcelikTIME COMPLETED:
01:40 PM
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On 03/19/2024 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. Three staff members and one client were interviewed during today's visit.

No deficiencies were cited in 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: 03/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/19/2024
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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