Facility Evaluation Report

At approximately 9:30 AM, Licensing Program Analyst (LPA) Robert Frank arrived unannounced to conduct a 1-Year Required inspection and was greeted by Administrator/Executive Director (ED), Stephanie Limberg. Ivy Park at Santa Rosa serves older adults in Assisted Living and Memory Care. Facility has a plan of operation for dementia care and programming on file. Facility has an approved fire clearance and total capacity for 114 non-ambulatory residents of which 14 residents may be bedridden. Facility has an approved hospice waiver for 12 residents. The facility consists of two (2) multi-level buildings. One (1) building is for assisted living. The other building is dedicated to memory care. Upon arrival, LPA was informed that there were one hundred one (101) Residents in care. At approximately 9:50 AM LPA reviewed Facility Staff Roster and found that all staff members on site were background cleared and associated to the facility per regulation.

At approximately 10:20 AM, LPA reviewed ten (10) resident files. Ten (10) of ten (10) resident files were observed to be well organized and thorough with all required documentation. LPA reviewed ten (10) staff files. Ten (10) of ten (10) staff files were observed to be well organized with all required documentation including First Aid and CPR certification and proper training documentation.

LPA unable to complete Annual Inspection. Annual Continuation Visit to be conducted at a later date.

No deficiencies cited during today's visit.

Exit interview conducted. Copy of report discussed and provided to ED Limberg. Signature on form confirms receipt of documents.