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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372006026
Report Date: 02/13/2025
Date Signed: 02/13/2025 11:01:47 AM

Document Has Been Signed on 02/13/2025 11:01 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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:IVEY RANCH PARK DAY CARE/RESPITE CTR. SCHOOL AGEFACILITY NUMBER:
372006026
ADMINISTRATOR/
DIRECTOR:		DANIELLY, TONYAFACILITY TYPE:
840
ADDRESS:110 RANCHO DEL ORO ROADTELEPHONE:
(760) 722-4839
CITY:OCEANSIDESTATE: CAZIP CODE:
92056
CAPACITY: 30TOTAL ENROLLED CHILDREN: 16CENSUS: 1DATE:
02/13/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Christina PaadTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) Keely Messerschmidt and Licensing Program Manager (LPM) Debbie Mullen arrived at the facility on a case management inspection to observe changes made in the facility in relation to a capacity change. In addition, LPA issued a citation based upon information discovered during investigation on complaint #20240911134232. During the investigation on 9/18/24 LPA discovered that an incident in which Child #1 (C1) was injured and sought medical care was not reported to Community Care Licensing (CCL).

An exit interview was conducted and a copy of this report was provided. Notice of site visit was provided and must remain posted for 30 days. Appeal Right were discussed and provided to Care Programs Manager Christina Paad.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Keely Messerschmidt
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2025
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 02/13/2025 11:01 AM - It Cannot Be Edited


Created By: Keely Messerschmidt On 02/12/2025 at 01:28 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
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: IVEY RANCH PARK DAY CARE/RESPITE CTR. SCHOOL AGE
FACILITY NUMBER: 372006026

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/13/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/14/2025
Section Cited
CCR
101212(d)(1)(B)

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(d) Upon the occurrence, during the operation of the child care center of any of the events specified in...(1)Events reported shall include the following:(B)Any injury to any child that requires medical treatment.
This requirement was not met as evidenced by,
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Care Programs Manager stated they will submit an Unusual Incident Report (UIR) for incident that took place with C1 and will continue to comply with regulations pertaining to reporting requirements.
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Based on interview, it was disclosed to LPA that a UIR was not completed for C1 injury which required parent to seek medical treatment. This is a potential risk to the health and safety of 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:Deborah Mullen
LICENSING EVALUATOR NAME:Keely Messerschmidt
LICENSING EVALUATOR SIGNATURE:
DATE: 02/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2025


LIC809 (FAS) - (06/04)
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