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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300610669
Report Date: 07/26/2024
Date Signed: 07/26/2024 01:48:25 PM

Document Has Been Signed on 07/26/2024 01:48 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
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:IVYCREST MONTESSORI PRIVATE SCHOOLFACILITY NUMBER:
300610669
ADMINISTRATOR/
DIRECTOR:		AIDA KINGFACILITY TYPE:
850
ADDRESS:2025 E. CHAPMAN AVENUETELEPHONE:
(714) 879-6091
CITY:FULLERTONSTATE: CAZIP CODE:
92831
CAPACITY: 214TOTAL ENROLLED CHILDREN: 214CENSUS: DATE:
07/26/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:05 PM
MET WITH:Director Aida KingTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
NARRATIVE
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On 07/26/24 at 1:05 p.m., Licensing Program Analyst (LPA), Christine Jung conducted an unannounced case management inspection to follow up on an incident that was self-reported to the Department. Upon arrival, LPA met with Director, Aida King. LPA disclosed the purpose of the inspection. There were no children present and one (1) staff present at time of arrival. Hours of operation are Monday through Friday 7:00 a.m. to 6:00 p.m.

On 5/16/24, facility reported Staff 1 (S1) noticed blood on Child 1’s (C1) nap bedding. S1 tried to inspect C1, but C1 refused and held their hand close to their chest. C1’s parent was called immediately. Parent arrived and determined that C1 had a cut on their finger, but C1 would not say how they incurred the injury. When S1 inspected the area surrounding C1’s nap mat, a small amount of blood was discovered on the outside of the AC vent which was close to C1. It was assumed that C1 had possibly stuck their finger into the vent and incurred a cut on the vent filter. The facility manager replaced the vent filter immediately after the incident.

Two (2) out of two (2) staff interviewed stated they did not witness the incident, and it was unclear as to how C1 incurred the injury; therefore, the licensee is being cited for buildings and grounds; see LIC 809D for Type B deficiency cited.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director, Aida King.

End of Report.
SUPERVISORS NAME: Martha Malane
LICENSING EVALUATOR NAME: Soo Jin Jung
LICENSING EVALUATOR SIGNATURE: DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/26/2024
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 07/26/2024 01:48 PM - It Cannot Be Edited


Created By: Soo Jin Jung On 07/26/2024 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: IVYCREST MONTESSORI PRIVATE SCHOOL
FACILITY NUMBER: 300610669

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/26/2024
Section Cited
CCR
101238(a)

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101238 Buildings and Grounds: The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.
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The facility stated they replaced the AC vent filter immediately on the day of the incident. The director stated the facility will check AC vents and filters monthly to ensure safety. The director stated they will add to closing staff checklist to check AC vent and filter.

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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:Martha Malane
LICENSING EVALUATOR NAME:Soo Jin Jung
LICENSING EVALUATOR SIGNATURE:
DATE: 07/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/26/2024


LIC809 (FAS) - (06/04)
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