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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198007162
Report Date: 04/03/2023
Date Signed: 04/03/2023 01:08:15 PM

Document Has Been Signed on 04/03/2023 01:08 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:RIVERA ELEMENTARY SCHOOLFACILITY NUMBER:
198007162
ADMINISTRATOR:ROBERTA GONZALEZFACILITY TYPE:
850
ADDRESS:7250 CITRONELL STREETTELEPHONE:
(562) 801-7656
CITY:PICO RIVERASTATE: CAZIP CODE:
90660
CAPACITY: 22TOTAL ENROLLED CHILDREN: 16CENSUS: 15DATE:
04/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Rocio Curiel Lead Teacher TIME COMPLETED:
01:15 PM
NARRATIVE
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At 11:20 AM Licensing Program Analyst (LPA) Roxana Lopez conducted an unannounced required inspection. A risk assessment was conducted prior to entering the facility appropriate PPE was used. LPA met with Lead Teacher, Rocio Curiel, who guided the LPA on a tour of the facility. This is a preschool age program licensed for 22 children which operates Monday – Friday. The facility consists of only one classroom with an AM program from 9:00 AM- 12:00 PM and PM program from 1:00 PM – 4:00 PM. Per Lead Teacher there are 16 children enrolled in each program.

All areas identified on the Facility Sketch were inspected. Facility is located in a bungalow on the Rivera Elementary School Campus. The following staff was present during this inspection: Staff #1, Staff #2 with 15 children; Teacher-child ratios were observed to be in accordance with Title 22 Regulations. Staff names were recorded. All children were observed to be under supervision, including visual supervision, of a teacher at all times. The licensed facility is within the conditions, limitations, and capacity specified on the license.

LPA observed the facility to be clean, sanitary and in good repair. Furniture and equipment were inspected for good repair, free of sharp, loose, or pointed parts. Classroom was inspected to ensure that the floors have a surface that is safe and clean. All toilets and washing facilities are in safe and sanitary operating conditions. All materials and surfaces accessible to children are toxic free.

At this time, the classroom is used as an isolation area. A corner is set up for away from the other children. Parents are contacted immediately when children are determined to be ill and staff are ensuring that children with obvious symptoms of illness are not being accepted. ------------------------------ pg. 1 of 4 ---------------
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 04/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/03/2023
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 6
Document Has Been Signed on 04/03/2023 01:08 PM - It Cannot Be Edited


Created By: Roxana Lopez On 04/03/2023 at 12:33 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
, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754

FACILITY NAME: RIVERA ELEMENTARY SCHOOL

FACILITY NUMBER: 198007162

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 04/03/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1597.16(a)(1)
Lead Testing
(1) A licensed child day care center, as defined in Section 1596.76, that is located in a building that was constructed before January 1, 2010, shall have its drinking water tested for lead contamination levels on or after January 1, 2020, but no later than January 1, 2023, and every five years after the date of the initial test.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in that Department has not received Water Lead Testing and LPA did not observed results posted in the facility which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/21/2023
Plan of Correction
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Per lead teacher they will speak to DIrector- so she can schedule testing.
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:Brandi VanOosten
LICENSING EVALUATOR NAME:Roxana Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 04/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/03/2023


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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: RIVERA ELEMENTARY SCHOOL
FACILITY NUMBER: 198007162
VISIT DATE: 04/03/2023
NARRATIVE
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The facility provides one snack per program. Per Lead Teacher snack is picked up every morning from the cafeteria and stored in the classroom refrigerator and or cabinets. All food preparation, and storage areas are clean, free of litter, rubbish, and rodents/vermin. All food is protected from contamination, and LPA inspected that any contaminated food is discarded immediately.

There is drinking water available in the classroom via personal water bottles and children take their water bottles outdoors. Dixie cups and water is available for children who forget their water bottles. All storage containers for solid waste, including moveable bins, have tight fitting covers. LPA did observed that the lid to big trash can outside is broken. Disinfectants, cleaning solutions, poisons and other items that are dangerous to children are stored in an area inaccessible to children.

LPA observed that there is smoke and carbon detectors in the facility and were found to be operable. The last Disaster and Fire Drill was conducted on 10/20/2022.

Facility shares outdoor playground with Kindergarten. A waiver and schedule is on file. Outdoor playground equipment is in safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space is maintained in a safe condition and is free of hazards. All areas around or under high climbing equipment, swings, slides, and similar equipment are cushioned with material that absorbs a fall. There is adequate shade in the play yard.

Sign in and out sheets were reviewed to ensure that the person who signs the child in and out uses their full legal signature and records the time of the day.

LPA did not review staff files during the inspection due to the staff files being stored at the administrative office. LPA will review staff files at a later time and date. Children's emergency records were reviewed; children's health records are kept in the administrative office and will be reviewed at a later time and date. If files were to be incomplete during the time and date that LPA reviews files, a case management inspection will occur at the facility to reflect the incomplete files.

Criminal Records Clearance for adults and verification of CPR/First Aid and health preventative


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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2023
LIC809 (FAS) - (06/04)
Page: 4 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: RIVERA ELEMENTARY SCHOOL
FACILITY NUMBER: 198007162
VISIT DATE: 04/03/2023
NARRATIVE
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Snack menus were reviewed to ensure that they are being posted at least one week in advance and visible to an authorized representative. practices documentation was reviewed. All staff have received an active criminal record clearance as a condition of their employment with the El Rancho Unified School District. LPA issued the Children’s Record Review (LIC 857) and the Staff’s Record Review (LIC 859) to the Director during this inspection.

AB1207 Mandated Child Abuse Reporting – On or before March 30, 2018 any person who works in a child care facility shall complete the training and renew the training every 2 years. Website provided: https://www.mandatedreporterca.com/training/child-care-providers
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This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Per Lead Teacher since program is only 3 hours children do not nap in the facility.

LPA consulted with staff regarding COVID-19 health and safety guidelines on this date.

LPA advised the licensee to access forms, regulations and quarterly updates on the Child Care Licensing website at: www.ccld.ca.gov

The department has not received Water Lead Testing for the facility. LPA reviewed new Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, which requires the testing of water for lead in Child Car
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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2023
LIC809 (FAS) - (06/04)
Page: 5 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME: RIVERA ELEMENTARY SCHOOL
FACILITY NUMBER: 198007162
VISIT DATE: 04/03/2023
NARRATIVE
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Centers (CCCs) with facility director during the inspection.Per AB 2370, all CCCs that are located in buildings constructed before January 1, 2010, must have their water tested and post the results by January 1, 2023, and every 5 years after the date of the first testing.

Grant funding will be available for testing and remediation of lead to the Child Care Centers that qualify. To make a determination of eligibility, refer to PIN 21-04-CCP. For Lead Testing and Prevention Information, including additional resources please visit https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information

Lead Teacher was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website atwww.cdss.ca.gov/inforesources/community-care-licensing/process

Based on the LPA’s observations and records reviews, the following deficiencies listed on the attached LIC 809D (deficiency page) are being cited in accordance with California Code od Regulations Title 22. Deficiencies that are being cited need to be cleared to protect the children’s health and safety.

A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with Lead Teacher Rocio Curiel and Blanca Zauzeta. ------------------------------------------ pg.4 of 4 --------------------------------------------------------------------
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2023
LIC809 (FAS) - (06/04)
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