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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304371459
Report Date: 08/31/2023
Date Signed: 08/31/2023 09:44:33 AM

Document Has Been Signed on 08/31/2023 09:44 AM - 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:IVYCREST MONTESSORIFACILITY NUMBER:
304371459
ADMINISTRATOR:OH, MICHELLEFACILITY TYPE:
850
ADDRESS:6555 FAIRMONT BLVD.TELEPHONE:
(714) 777-2511
CITY:YORBA LINDASTATE: CAZIP CODE:
92886
CAPACITY: 112TOTAL ENROLLED CHILDREN: 85CENSUS: 37DATE:
08/31/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Director, Michelle OhTIME COMPLETED:
10:15 AM
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An unannounced Case Management inspection conducted on this date by Licensing Program Analyst (LPA) Nguyen to provide the facility a copy of an amended LIC 9099 report, update the LIC 9099D page dated 08/07/2023, and obtain signatures. Upon arrival LPA met with Michelle Oh, Director who accompanied LPA on a tour of the facility. Census was taken as follow: 9 toddlers, 28 preschool children with 9 staff members. A review of staff criminal records indicates all facility staff or individuals who require caregiver background checks have received a criminal record clearance or exemption and a child abuse index clearance.

Please see "Amended" LIC 9099 report dated 08/07/2023 and updated LIC 9099D page for correction.

There were no Title 22 deficiencies cited during today's inspection.

Exit interview was conducted with Director Michelle, Oh. Notice of Site Visit was posted during the visit. Director was informed that the notice of site visit must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100. Director was provided a copy of their appeal rights (LIC 9058 01/16) and their signature on this form acknowledges receipt of these rights. First level appeals should be sent to the regional manager to the address listed above.

SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Cindy Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2023
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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