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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604613
Report Date: 12/21/2023
Date Signed: 12/21/2023 04:25:20 PM

Document Has Been Signed on 12/21/2023 04:25 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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:OCEANSIDE IVEY RANCH PARK ASSOCIATIONFACILITY NUMBER:
374604613
ADMINISTRATOR:DANIELLY, TONYAFACILITY TYPE:
775
ADDRESS:110 RANCHO DEL ORO DRIVETELEPHONE:
(760) 722-4839
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY: 12CENSUS: 11DATE:
12/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Administrator Tonya DaniellyTIME COMPLETED:
04:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced Required 1-Year visit. The facility file was reviewed prior to the visit. LPA was greeted by, identified herself to, and explained the purpose of the visit with Administrator Tonya Danielly.

The facility is licensed for a maximum capacity of 12 clients, 2 of which may be non-ambulatory. During today’s visit, the facility had a census of 11 clients, all of which were ambulatory. The Administrator for the facility is Tonya Danielly and their certificate was valid and current.

During today’s visit, LPA toured the facility and inspected each room of the facility, including rooms for client use, bathrooms for client use, kitchen, and outside space. No bodies of water were observed near or on the premises. LPA did not observe any aspects of delayed egress or secured perimeter. Interviews with the staff and Administrator, as well as LPA observation revealed that a child day-care facility is operated on the property and both populations were present at the same time during LPA's visit. Interviews with facility staff revealed that the most recent fire clearance inspection was conducted on 9/22/2022 and approved the facility for 12 adult clients. Previous fire clearance was approved for 48 children. Per Administrator, around June 2023, the facility swapped rooms for the childcare facility and the adult day program facility without updating facility fire clearance for changed population types. The facility was found to be clean, safe, and in good repair with no pathway obstructions. The facility’s water temperature was measured at 66.5 degrees Fahrenheit in a client bathroom. Per Administrator, clients do not have access to hot water for handwashing or grooming purposes. The facility’s internal temperature was measured at 70 degrees Fahrenheit. LPA observed locked storage for all hazardous and/or toxic chemicals and were stored separately from food supplies. LPA also observed locked storage for client medications and client and staff files. Staff present at the facility during the time of the inspection had a criminal background clearance, however, Staff 1, Staff 2, Staff 3, and Staff 4 (S1-S4) were not associated to the facility. Interviews with the Administrator revealed that S1-S4 had been working at the facility for more than 5 days.
Continued on LIC809-C page...
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE: DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/21/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
Document Has Been Signed on 03/12/2024 02:37 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 03/12/2024 01:38 PM


Created By: Rebecca A Ruiz On 12/21/2023 at 03:37 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: OCEANSIDE IVEY RANCH PARK ASSOCIATION
FACILITY NUMBER: 374604613

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82020
Fire Clearance
All day programs shall secure through the licensing agency and maintain a fire clearance approved by the city or county fire department, the district providing fire protection services, or the State Fire Marshal.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA’s interviews, observations and record review, the licensee did not comply with the section cited above by changing the use of the ADP rooms with childcare center rooms. This change was not approved by the Fire Department and not on the approved fire clearance. This poses an immediate safety risk to persons in care.
This is an amended version of the original report dated 12/21/2023.
POC Due Date: 12/22/2023
Plan of Correction
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Administrator stated that she will contact Oceanside Firefighters Association and request updated fire clearance to speak to and identify separate spaces and rooms for both populations. Administrator will provide Department with proof of request by POC due date of 12/22/2023.
Type A
Section Cited
CCR
82019(e)(3)
Criminal Record Clearance
(e) Prior to working, residing or volunteering in a licensed day program, all individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall do the following: (3) Request the licensee or applicant for a license to request a transfer of a criminal record clearance as specified in Section 82019(f); or

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA’s observations, interviews and record review, the licensee did not comply with the section cited above in that 4 of 4 staff providing care and supervision did not have a criminal record clearance transfer which poses and immediate health & safety risk to persons in care.
This is an amended version of the original report dated 12/21/2023.
POC Due Date: 12/22/2023
Plan of Correction
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Administrator stated that she will submit the criminal background statement, staff idenfitication documents, and request for criminal background transfer to the Department by POC due date of 12/22/2023.
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:Lizzette Tellez
LICENSING EVALUATOR NAME:Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE:
DATE: 12/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/21/2023


LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 03/12/2024 02:37 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 03/12/2024 01:37 PM


Created By: Rebecca A Ruiz On 12/21/2023 at 03:37 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: OCEANSIDE IVEY RANCH PARK ASSOCIATION
FACILITY NUMBER: 374604613

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA’s observations, the licensee did not comply with the section cited above by not maintaining hot water temperature. Hot water temperature was found to be 66.5 degrees, not at the required temperature of 105-120 degrees. This poses a potential health & safety risk to persons in care.
This is an amended version of the original report dated 12/21/2023.
POC Due Date: 01/18/2024
Plan of Correction
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Administrator stated that she will contact the plumber to provide the sink in the client bathroom with hot water. Administrator will provide documentation regarding scheduling and approving plumbing work to the Department by POC due date of 1/18/2023
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Lizzette Tellez
LICENSING EVALUATOR NAME:Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE:
DATE: 12/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/21/2023


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: OCEANSIDE IVEY RANCH PARK ASSOCIATION
FACILITY NUMBER: 374604613
VISIT DATE: 12/21/2023
NARRATIVE
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LPA reviewed multiple client and staff records. Each client record was complete and contained a signed admission agreement, updated medical assessment, and personal rights. Each staff file contained a personnel record, first aid certificate, fingerprint clearance, and a health screening. LPA spoke with staff present during the inspection and those interviews did not reveal any licensing or regulatory concerns. LPA was unable to interview clients due to clients being out in the community during the majority of the LPA's inspection.

The following deficiencies for hot water, fire clearance and staff association are cited per CA Code of Regulations Title 22 and noted on the attached LIC809-D page. In addition, civil penalties are being assessed for fire clearance and criminal record clearance transfer in the amount of $2,500 and are noted on the attached LIC421IM and LIC421BG.



An exit interview was conducted with Administrator Tonya Danielly, whose signature below confirms receipt of a copy of this report, LIC421IM, LIC421BG, and the Licensee Appeal Rights (LIC9058 01/16).

This is an amended version of the original report dated 12/21/2023.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2023
LIC809 (FAS) - (06/04)
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