Ivy Park at Rockville

Type of visit: Prelicensing

At approximately 09:30 AM, Licensing Program Analyst (LPA) Star Stevenson arrived unannounced to conduct a Pre-Licensing inspection for a Change of Ownership (CHOW) and was greeted Applicant Representative Tedra Godfrey. (AR) Facility received a fire clearance on 11/17/2025 to care for 199 residents including 169 non-ambulatory and 30 bedridden residents. Bedridden residents can be served on both 1st and 2nd floors. Facility is noted to have emergency evacuation chairs at the top of each fire hardened stairwell. The current facility has a hospice clearance for 20 residents with a plan to care for 30 hospice residents. Facility has an Emergency and Disaster plan, as well as Infection Control plan on file. At approximately 10:15 AM, LPA initiated a tour of the facility with AR and observed the following: The facility staffs a receptionist and seating area at the main entrance. The two-story entry way has views of the larger of two Courtyards, Activity room, large Dinning room and separate cafe-style dinning area, as well as a centralized seating area with piano. A centrally located resident Mail Room has required Compliant, Theft Policy, Resident Rights and Resident Council Rights posters. Hallways throughout the property have 4 fire extinguishers each that were all observed to be fully charged and last inspected in June of 2026. Hallways were observed to be unobstructed and exit doors with audible wander alerts were clearly marked. Stairwells were noted to have emergency pull cords Continued on LIC809-C Continued from LIC809 Facility has two courtyards in assisted living and a 3rd courtyard in memory care. Facilities delayed egress doors were observed to be label properly and functioning correctly. Facility has an activity room, large theater room, sitting library and upstairs hair saloon. Upstairs portion of the building is accessible by multiple elevators and stairs. Facility cleaners and toxins are stored in locked housekeeping supply rooms. Housekeeping carts are lockable and were found to be locked while in use. LPA observed plenty of perishable and nonperishable foods. The kitchen and dining area clean and well maintained. Water temperature measured within regulation between 105 and 120 degrees F in various resident bathrooms in both Assisted Living and Memory care. LPA observed the facility has a hard wired fire alarm system and automatic fire sprinkler system which passed inspections on 11/17/2025 and 11/06/2025 and will soon undergo repeat annual inspections. Medication is centrally stored and locked in a dedicated medication room in the assisted living and memory care sections of the building. Resident medical records are also kept locked and inaccessible. The facility has multiple pull station fire alarm with audio/visual alert, and all resident bathrooms have pull cords for alerting staff for assistance. Residents also receive a pendant to keep with them. Facility has the required 7 days non-perishable and 2 days perishable food on hand. Foods in both the refrigerator and freezer rooms of the central kitchen were noted to be clean and foods well labeled, including foods that had been taken out of the original commercial packaging. Based on their knowledge shown, the AR has successfully completed the Component lll Orientation section of the application process. Current Executive Director Godrey has been the appointed administrator of this facility for approximately 1.5 years prior to this ownership change, and has shown a thorough understanding of Title 22 regulations and applicable Health and Safety Codes. Continued on LIC809-C Continued from 809-C LPA and AR discussed the following items: · The need for updated Liability Insurance once new licensed is issued. · Guardian background clearances and associations - Applicant understands that all current staff members associated to Ivy Park at Rockville (486803653) will need to be transferred and associated to new facility license (486804395) once approved. LPA will submit Pre-Licensing Application Report to the Application Unit Analyst in Sacramento. Application Unit Analyst will notify Applicant of Status. Exit interview conducted with Tedra Godfrey (Applicant Representative) Copy of report discussed and provided. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Aug 7, 2026