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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198011340
Report Date: 08/16/2024
Date Signed: 08/16/2024 11:01:30 AM

Document Has Been Signed on 08/16/2024 11:01 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: 69CENSUS: 62DATE:
08/16/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:Denise Maria, Child Supervisor Denise Maria TIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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At 9:50 am Licensing Program Analysts (LPAs) Roxana Lopez and Prscilla Ochoa 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 05/28/2024 LPAs met with Child Development Site Supervisor Denise Maria, who gave LPAs a tour of the facility.

On 05/28/2024 an incident was self reported to the department within the required 24 hours. Per Incident reported On 5/24/2024 Child # 1 was running during outdoor time and bumped into a peer landing on right elbow. Teacher noticed red marking and applied ice- child was able to move arm up and down. On 5/28/2024 Parent informed teacher that they had taken Child # 1 to the ER and child had a cast.

LPA conducted interviews with staff, incident was observed and first aid was provided. Child # 1 came back to school with a doctors note stating limitations for two weeks. Children no longer enrolled in the facility.

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 and Denise Maria.
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 08/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/16/2024
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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