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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543801302
Report Date: 01/25/2022
Date Signed: 01/25/2022 10:04:44 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:IVANHOE ELEMENTARY SCHOOL PRESCHOOLFACILITY NUMBER:
543801302
ADMINISTRATOR:CARDOZA, DEBORAHFACILITY TYPE:
850
ADDRESS:16030 AVENUE 332TELEPHONE:
(559) 730-7849
CITY:IVANHOESTATE: CAZIP CODE:
93235
CAPACITY:24CENSUS: 4DATE:
01/25/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Lead Teacher, Casey PulaskiTIME COMPLETED:
10:15 AM
NARRATIVE
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On 1/25/2022, LPA Jose Penate arrived at facility to conduct a Case Management inspection due to a previous inspection visit. LPA Penate spoke with Lead Teacher, Casey Pulaski and discussed the purpose of the inspection. A tour of the facility was conducted both inside and outside and census was taken.

Based on interviews that were conducted, it was determined that the staff at the facility utilized an Unapproved classroom for children during a power outage. LPA confirmed that the power was out on Monday, October 25th and Tuesday, October 26th. On both days the staff decided to use classroom #1 and that classroom was not fire cleared to have any children in the room at that time.

Per California Code of Regulations, Title 22, Division 12, the following deficiency is being cited on the attached LIC809-D, see next page.



Exit interview was conducted with Lead Teacher, Casey Pulaski.

A Notice of Site Visit Form was posted and must remain posted for 30 days.

The licensee was provided a copy of their appeal rights and their signature on this form acknowledges receipt of this form.

SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Jose PenateTELEPHONE: (559) 341-5860
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: IVANHOE ELEMENTARY SCHOOL PRESCHOOL
FACILITY NUMBER: 543801302
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/25/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/11/2022
Section Cited

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A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation. LPA confirmed that the power was out on Monday, October
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25th and Tuesday, October 26th. On both days the staff decided to use classroom #1 and that classroom was not fire cleared to have any children in the room at that time. This is an potential health and safety risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Jose PenateTELEPHONE: (559) 341-5860
LICENSING EVALUATOR SIGNATURE:
DATE: 01/25/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/25/2022
LIC809 (FAS) - (06/04)
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