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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372006026
Report Date: 10/24/2023
Date Signed: 10/24/2023 04:07:20 PM

Document Has Been Signed on 10/24/2023 04:07 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
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:DANIELLY, TONYAFACILITY TYPE:
840
ADDRESS:110 RANCHO DEL ORO ROADTELEPHONE:
(760) 722-4839
CITY:OCEANSIDESTATE: CAZIP CODE:
92056
CAPACITY: 30TOTAL ENROLLED CHILDREN: 9CENSUS: 0DATE:
10/24/2023
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Tonya DaniellyTIME COMPLETED:
03:00 PM
NARRATIVE
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On day and time listed above, Licensing Program Analyst (LPA) Keely Messerschmidt, made an unannounced Case Management inspection, for reported Lead Exceedance. LPA met with Director Tonya Danielly notifying her the reason of todays visit. There were no children present during the inspection. LPA Keely Messerschmidt interviewed the Director and examined the faucet deemed an Action Level Exceedance.

Label B: Faucet reported with 12 ppb or greater lead exceedance levels were as follows:

1 faucet identified as having high levels of lead. The faucet is located in the school-age classroom. Director stated that the piping has since been replaced resolving the lead exceedance and is not being used for drinking water or food preparation, only for art supply cleaning and teacher use only.

Based on records review and information received after January 1, 2023, and current policies and procedures for the Department, the facility is being cited for having a lead exceedance in faucet labeled letter B, under the Written Directives, Section 101700.3 (b) (1) California Lead Action Level at Child Care Centers. This poses a potential health, safety, or personal rights risk to the children in care.

An exit interview was conducted, a copy of this report, LIC809D and appeal rights were handed to facility Director, Tonya Danielly. A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Keely Messerschmidt
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2023
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 2
Document Has Been Signed on 10/24/2023 04:07 PM - It Cannot Be Edited


Created By: Keely Messerschmidt On 10/24/2023 at 03:26 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: 10/24/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/24/2023
Section Cited
HSC
101700.3(b)(1)

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California Lead Action Level at Child Care Centers(b) Testing results with fractional ppb readings of 0.5 ppb or greater shall be rounded up to the nearest whole number, before comparing to the Action Level. (1) A result with values of 5.5 ppb or greater shall be deemed an :
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Director agrees to write a letter stating that the piping has since been resolved and state what the faucet is being used for, as well as attaching proof of correction and submit to LPA via email by 11/24/23.
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Action Level Exceedance. This requirement was not met as evidenced by, based on records review and interviews, facility tested over the Action Level Exceedance at 12, in one faucet in school-age classroom. This poses a potential health, safety, or personal rights risk to the 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: 10/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/24/2023


LIC809 (FAS) - (06/04)
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