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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153810190
Report Date: 09/27/2024
Date Signed: 10/04/2024 12:21:55 PM

Document Has Been Signed on 10/04/2024 12:21 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
FRESNO SOUTH CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:CAL IVY PREP AT CSUBFACILITY NUMBER:
153810190
ADMINISTRATOR/
DIRECTOR:		MAIDEN, DARNISHAFACILITY TYPE:
850
ADDRESS:9001 STOCKDALE HWYTELEPHONE:
(661) 654-3165
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY: 79TOTAL ENROLLED CHILDREN: 79CENSUS: 40DATE:
09/27/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:35 AM
MET WITH:Miranda PettisTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
NARRATIVE
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On 09/27/2024, an unannounced case management visit was conducted by Licensing Program Analysts (LPAs) Nohemi Sanchez and Lady Cabrera. The purpose of today's visit was to complete a complaint investigation, but a deficiency issue was noted. During the complaint investigation, per records reviewed it was determined that Staff #1, was not cleared based on Guardian employee roster. Staff #1 has been employed since 12/26/2023, which was confirmed by Assistant Director Miranda Pettis.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiency is being cited. Civil penalty was assessed.

Exit interview conducted and report was reviewed with Site Supervisor Hanan Abou Harb. Appeal rights were provided.

LPA Sanchez informed Assistant Director Miranda Pettis that this report dated 09/27/2024 document one (1) Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Sanchez informed the Assistant Director to provide a copy of this licensing report dated 09/27/2024 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days

SUPERVISORS NAME: Luisa Gavoutian
LICENSING EVALUATOR NAME: Nohemi Sanchez
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2024
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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Document Has Been Signed on 09/27/2024 02:16 PM - It Cannot Be Edited


Created By: Nohemi Sanchez On 09/27/2024 at 01:48 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: CAL IVY PREP AT CSUB
FACILITY NUMBER: 153810190

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/30/2024
Section Cited
CCR
101170(e)(1)

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101170 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working... in a licensed facility: (1)Obtain a California clearance...This requirement is not met as evidenced by:
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Licensee stated effective immediately, Staff #1 will not be present in the facility during operating hours until facility receives their background clearances by 09/30/2024.
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Based on a record review and interview, the licensee did not comply with the section cited above. Staff #1, who is present today, is not fingerprint cleared, which poses an immediate health, safety or personal rights risk to persons 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:Luisa Gavoutian
LICENSING EVALUATOR NAME:Nohemi Sanchez
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2024


LIC809 (FAS) - (06/04)
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