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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198011340
Report Date: 05/09/2024
Date Signed: 05/09/2024 10:30:10 AM

Document Has Been Signed on 05/09/2024 10:30 AM - 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/
DIRECTOR:
LISA DUNBARFACILITY TYPE:
850
ADDRESS:4300 ESTOTELEPHONE:
(626) 453-3700
CITY:EL MONTESTATE: CAZIP CODE:
91731
CAPACITY: 150TOTAL ENROLLED CHILDREN: 125CENSUS: 109DATE:
05/09/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Child Development SIte Supervisor Elsa Gomez TIME VISIT/
INSPECTION COMPLETED:
10:35 AM
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At 9:10 am Licensing Program Analyst (LPA) Roxana Lopez conducted an unannounced case management- incident inspection to the above facility. The purpose of this inspection was to follow-up on 2 incidents that were self- reported to the department on 12/19/2023 and 3/28/2024. LPA met with Child Development Site Supervisor Elsa Gomez, who gave LPA a tour of the facility.

On 12/19/2023 an incident was self reported to the department within the required 24 hours. Per Incident reported Parent disclosed Child # 1 had some markings on body.

On 3/28/2024 an incident was self reported to the department within the required 24 hours. Per incident reported Child # 2 had fallen hitting forehead on an easel.

Regarding incident # 1 LPA conducted interview with staff, no new disclosures were made- A DCFS report was made regarding incident. Regarding incident # 2 LPA observed the area and took pictures where incident happened. Staff was interviewed- Staff disclosed that child was taken to the doctor for follow-up and was back the next day with no restrictions or concerns.

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 Elsa Gomez.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2024
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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