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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153808781
Report Date: 04/21/2022
Date Signed: 04/21/2022 01:59:22 PM


Document Has Been Signed on 04/21/2022 01:59 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
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710



FACILITY NAME:CALIFORNIA IVY LEAGUE PREP ACADEMY, PS & ICFACILITY NUMBER:
153808781
ADMINISTRATOR:MILLER, AMYFACILITY TYPE:
840
ADDRESS:2301 ASHE ROADTELEPHONE:
(661) 832-8300
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY:40CENSUS: 0DATE:
04/21/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Director, Amy MillerTIME COMPLETED:
02:15 PM
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On 04/21/2022, Licensing Program Analyst (LPA) Jose Penate met with Director, Amy Miller for an unannounced case management inspection. LPA toured the facility and took a census. An unusual Incident Report was submitted to the Fresno Community Care Licensing Office (CCL) regarding an incident that occurred on 04/14/22, where Child #1 was running in the outdoor playground, child was running from the West end to the East end and fell while playing in the rubber mulch area. Child tripped and fell while jumping from the mulch area onto the pavement area, he tripped over the barrier that separates the two sections. LPA verified that the playground has sufficient rubber mulch and is safe for children to play. The child did injure his arm but it was not due to the playground being unsafe. The purpose of this inspection was to investigate the aforementioned incident.

LPA discussed incident with teacher, La’recia Torres who stated on 04/14/22, in the playground child #1 tripped on his own with no obstructions surrounding him. When child stood up, he complained of pain in his arm, after checking on child director stated that he complained about pain in his upper arm area. Staff applied an ice pack on child and parents were called immediately and they arrived within 45mins of injury. Director stated that the facility has a Lesson Plan in effect when children are outdoors in the playground area, teachers and staff are staggered and walking the areas for proper supervision.

LPA toured play area for any obstructions that would not allow proper supervision by staff to the children in care. LPA did not observe any obstructions for proper supervision of children in care.

Exit interview was conducted with Director, Amy Miller.

Per California Code of Regulations, Title 22, Division 12, no deficiency was cited during today’s visit.

SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559)650-7855
LICENSING EVALUATOR NAME: Jose PenateTELEPHONE: (559) 341-5860
LICENSING EVALUATOR SIGNATURE:
DATE: 04/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/21/2022
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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