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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315920222
Report Date: 03/11/2025
Date Signed: 03/11/2025 11:57:29 AM

Document Has Been Signed on 03/11/2025 11:57 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 AT BLUE OAKS, THEFACILITY NUMBER:
315920222
ADMINISTRATOR/
DIRECTOR:		SWEARINGEN, MICHELLEFACILITY TYPE:
740
ADDRESS:275 ROSEVILLE PARKWAYTELEPHONE:
(916) 432-2878
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY: 157CENSUS: 71DATE:
03/11/2025
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Michelle SwearingenTIME VISIT/
INSPECTION COMPLETED:
12:10 PM
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Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility announced on March 11, 2025 to conduct a Post-licensing inspection utilizing the CARE tool. LPA met with the Executive Director and explained the purpose of the visit.

LPA toured the interior and exterior of the facility and safety of residents in care. Areas toured include but are not limited to: common areas, kitchen, laundry room, outdoor areas- In the areas toured no immediate health, safety concerns observed an are clean and well maintained.

There are currently 71 residents present.

LPA reviewed 3 resident files and 3 staff files. Files are complete and well organized. LPA and ED discussed updated regulations, effective 1/1/25, for resident documents and staff training.

As a result of today's inspection, no deficiencies are cited.

Exit interview conducted and copy of report left at the facility.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE: DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2025
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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