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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198011340
Report Date: 09/21/2023
Date Signed: 09/21/2023 04:43:18 PM

Document Has Been Signed on 09/21/2023 04:43 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:EL MONTE CITY SCHOOL DIST.-RIO VISTA SCHOOLFACILITY NUMBER:
198011340
ADMINISTRATOR:LISA DUNBARFACILITY TYPE:
850
ADDRESS:4300 ESTOTELEPHONE:
(626) 453-3700
CITY:EL MONTESTATE: CAZIP CODE:
91731
CAPACITY: 150TOTAL ENROLLED CHILDREN: 63CENSUS: 16DATE:
09/21/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:50 PM
MET WITH:Zarahi Alvarez TIME COMPLETED:
05:00 PM
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At 3:50 pm Licensing Program Analysts (LPAs) Roxana Lopez and Stacy Perry conducted an unannounced case management- incident inspection to the above facility. The purpose of this inspection was to follow-up on an incident that was self- reported to the department on 7/21/2023. LPA's met with Office Assistant Zarahi Alvarez, who informed LPAs that there was no administration on cite to provide LPAs with a tour as they were in a meeting. LPAs took a tour of the facility on their own and census was taken. Supervisor Denise Maria arrived at 4:31 pm

On 7/21/2023 an incident was self reported to the department within the required 24 hours by Facility Representative Guillermina Diaz-Huerta . Per Incident reported Child # 1 was sliding from a slide on the structure hitting their ear and ice pack was provided and parents were informed

LPAs observed the structure and took pictures where incident happened. Staff was interview and documentation was reviewed. Staff disclosed that child was taken to the doctor for follow-up and was back the next day with no restrictions.

At this time, the licensee is in compliance with California Code of Regulations Title 22. No deficiencies cited.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the facility representative Denise Maria
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 09/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/21/2023
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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