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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153810190
Report Date: 10/04/2024
Date Signed: 10/04/2024 12:24:01 PM

Document Has Been Signed on 10/04/2024 12:24 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: 44DATE:
10/04/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:20 AM
MET WITH:Amy MillerTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
NARRATIVE
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On 10/04/2024, Licensing Program Analysts (LPAs) Nohemi Sanchez and Lady Cabrera conducted an unannounced case management inspection to amend report, LIC 809 dated 09/27/2024.

LPAs met with Director Amy Miller and discussed amended report. LPA Sanchez and Amy Miller signed the amended report.


During a complaint investigation, LPA Sanchez discovered per records reviewed and interviews, Community Care Licensing (CCL) did not receive an Unusual Incident Report by telephone or fax within the CCL’s next working day and during its normal business hours. Per Assistant Director and Site Supervisor they were not aware of the minimum number of active communicable diseases cases needed to be reported to CCL. Facility did not comply with the reporting requirements regulations. LPA Sanchez reviewed 101212 Reporting Regulations Requirements with Director.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiency is being cited. Director Amy Miller was provided a copy of their appeal rights.

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: 10/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2024
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 10/04/2024 12:24 PM - It Cannot Be Edited


Created By: Nohemi Sanchez On 10/04/2024 at 11:49 AM
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: 10/04/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/18/2024
Section Cited
CCR
101212(d)

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101212 Reporting Requirements (d) Upon the occurrence, during the operation of the childcare center of any of the events specified in (d)(1) below, a report shall be made to the Department ...This requirement was not met as evidenced by:
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LPA reviewed Reporting Requirements with Licensee and provided a copy. Directed stated they will review 101212 Reporting Requirements regulation and train all Management. Director will submit to the Fresno South Licensing Office a training outline and a sign in sheet by 10/11/2024.
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Based on interviews and records reviewed, Licensee did not comply with the cited regulation, which poses a potential risk to the health, safety, or personal rights 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:Luisa Gavoutian
LICENSING EVALUATOR NAME:Nohemi Sanchez
LICENSING EVALUATOR SIGNATURE:
DATE: 10/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/04/2024


LIC809 (FAS) - (06/04)
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