<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 365530195
Report Date: 09/05/2024
Date Signed: 09/09/2024 04:03:46 PM


Document Has Been Signed on 09/09/2024 04:03 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, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507



FACILITY NAME:IVY PARK AT ALTA LOMAFACILITY NUMBER:
365530195
ADMINISTRATOR:SANCHEZ, JENNIFERFACILITY TYPE:
740
ADDRESS:9519 BASELINE ROADTELEPHONE:
(909) 941-3001
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91730
CAPACITY:77CENSUS: 61DATE:
09/05/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jennifer Sanchez, Executive DirectorTIME COMPLETED:
12:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 09/05/2024 at 09:00 AM, Licensing Program Analyst (LPA) Javier Prieto and LPA LaVette Farlow conducted an announced Pre-licensing visit. This is an announced Pre-Licensing visit conducted with Executive Director Jennifer Sanchez who assisted in the tour of inside and outside of the facility and the evaluation.

The facility has the proper posting throughout the facility.

The facility was evaluated in accordance with the California Code of Regulation (CCR), Title 22 Chapter 6, Division 8. Based on the observations and evaluation of the facility this date, the facility’s ready for licensure.



A COMP III orientation was also conducted during today's visit with .

The Applicant will be notified once facility is licensed.

An exit interview was conducted, and a copy of this report (LIC809) was discussed and provided with Executive Director Jennifer Sanchez.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Javier PrietoTELEPHONE: 951-217-3135
LICENSING EVALUATOR SIGNATURE:
DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 3 of 3