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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 283009663
Report Date: 05/25/2022
Date Signed: 05/25/2022 02:30:50 PM

Document Has Been Signed on 05/25/2022 02:30 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:LITTLE IVY PRESCHOOLFACILITY NUMBER:
283009663
ADMINISTRATOR:KAYLEE ANDRESFACILITY TYPE:
850
ADDRESS:2201 PINE STREETTELEPHONE:
(707) 257-1185
CITY:NAPASTATE: CAZIP CODE:
94559
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 32DATE:
05/25/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Kaylee Adres, DirectorTIME COMPLETED:
02:45 PM
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LPA made an unannounced inspection/ visit to follow up on an unusual incident on 5/18/22 of an interaction between two people that could have resulted in a supervision or personal rights violation.
LPA toured the facility, interviewed staff, children, and reviewed documents.
Staff were interviewed and were present and apparently very close by during said interaction and did not observe anything occur out of the ordinary.
The facility has implemented a plan encouraging open communication through
education at circle time and through books for support.

After touring and interviews there does not appear to be any supervision or personal rights issues.

No title 22 regulations were cited today.
A Notice of Site Visit is to be posted for 30 days from today.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Kevin O'Connell
LICENSING EVALUATOR SIGNATURE: DATE: 05/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2022
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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