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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153808780
Report Date: 02/26/2025
Date Signed: 02/26/2025 02:39:06 PM

Document Has Been Signed on 02/26/2025 02:39 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
FRESNO SOUTH CC RO, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:CALIFORNIA IVY LEAGUE PREP ACADEMY, PS & ICFACILITY NUMBER:
153808780
ADMINISTRATOR/
DIRECTOR:		MILLER, AMYFACILITY TYPE:
850
ADDRESS:2301 ASHE ROADTELEPHONE:
(661) 832-8300
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 178TOTAL ENROLLED CHILDREN: 178CENSUS: 78DATE:
02/26/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Amy Miller TIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
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On 02/26/25 Licensing Program Analyst (LPA) Denisia Jimenez arrived at the facility to conduct an unannounced Case Management Inspection. LPA took a census. An Unusual Incident was reported to Community Care Licensing on 02/14/25.

On 02/13/25 Parent #1 spoke to Regional Director Amy Miller regarding an incident that occurred with Child #1 and Staff #1 on 02/12/25. Child #1 alleged that Staff #1 had squeezed its arm. Staff #1 stated that child #1 was having a hard time following directions and child #1 had hit staff #1 a couple of times. Staff #1 stated they grabbed Child #1 by its left arm and told them not to be hitting and throwing toys at them. Staff #1 caused marks and bruises on its left arm by the bicep area. Child #1 did not require medical attention. Facility immediately suspended Staff #1 pending investigation.

Per Title 22, Division 12, of the California Code of Regulations, the following deficiency is being cited: (see next page).

LPA Denisia Jimenez informed Regional Director that this report dated 02/26/25 document 1 Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care. Also, LPA Denisia Jimenez informed the Regional Director to provide a copy of this licensing report dated 02/26/25 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

A copy of the Fact Sheet - Child Care Parent Notification Requirements and a copy of LIC 9224 Acknowledgement of Receipt of Licensing Reports was given to Regional Director, Amy Miller.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISORS NAME: Scott Herring
LICENSING EVALUATOR NAME: Denisia Jimenez
LICENSING EVALUATOR SIGNATURE: DATE: 02/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/26/2025
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 02/26/2025 02:39 PM - It Cannot Be Edited


Created By: Denisia Jimenez On 02/26/2025 at 12:21 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
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: CALIFORNIA IVY LEAGUE PREP ACADEMY, PS & IC
FACILITY NUMBER: 153808780

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/26/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/26/2025
Section Cited
CCR
101223(a)(3)

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101223 Personal Rights
(a)The licensee shall ensure that each child is accorded the following personal rights: (3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature including but not limited to: interference with functions of daily living including eating, sleeping or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.
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Director immediately suspended Staff #1 02/13/25 and is pending investigation.
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This requirement was not met as evidenced by Staff #1 grabbing child #1 by the arm and leaving marks and bruises. Staff #1 is suspended pending investigation. This is an immediate danger to the health, safety or personal rights 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:Scott Herring
LICENSING EVALUATOR NAME:Denisia Jimenez
LICENSING EVALUATOR SIGNATURE:
DATE: 02/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/26/2025


LIC809 (FAS) - (06/04)
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