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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198011340
Report Date: 09/30/2024
Date Signed: 09/30/2024 03:48:02 PM

Document Has Been Signed on 09/30/2024 03:48 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/
DIRECTOR:
LISA DUNBARFACILITY TYPE:
850
ADDRESS:4300 ESTOTELEPHONE:
(626) 453-3700
CITY:EL MONTESTATE: CAZIP CODE:
91731
CAPACITY: 150TOTAL ENROLLED CHILDREN: 88CENSUS: 82DATE:
09/30/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Child Development Supervisor Elsa Gomez TIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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Licensing Program Analysts (LPA) Roxana Lopez conducted an unannounced case management- incident inspection to the above facility. The purpose of this inspection was to follow-up on two incidents that were self- reported to the department on 09/12//2024 and 9/30/24 LPA met with Child Development Site Supervisor Elsa Gomez, who gave LPA a tour of the facility.

On 09/12/2024 an incident was self reported to the department within the required 24 hours. Per Incident reported On 9/12/2024 Child # 1 was sleeping when teachers noticed child's eyes were fluttering but not opening. Child was transported to the hospital.

On 09/30/2024 during annual inspection an incident was reported to LPA- as 911 was being called for child #2 that was feeling ill- Child was transported to the hospital.

LPA conducted interviews with staff, regarding incident # 1- teachers called 911 after monitoring child and noticing that child was not waking up- child was breathing but not waking up. When paramedics arrived vitals were taken and they attempted to wake child up but child was not responding. Child was transported to the hospital- child woke up when transitioned into the stretcher. Per staff child is not back.

Regarding incident # 2- class was transitioning inside from outdoors, child # 2 informed teacher that they were feeling ill and child's legs were wobbly falling into teacher's arms. 911 was called- instructions were followed until paramedics arrived. ------------------------- pg, 1 of 2 -----------------------
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 09/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/30/2024
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
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: EL MONTE CITY SCHOOL DIST.-RIO VISTA SCHOOL
FACILITY NUMBER: 198011340
VISIT DATE: 09/30/2024
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Child was transported to the hospital accompanied by staff. Interviews disclosed that child was playing in the grass area and was observed drinking water twice before transitioning inside,

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 representatives Elsa Gomez and Denise Maria.

------------------------------------------------------------------ pg.2 of 2 --------------------------------------------------------------
SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2024
LIC809 (FAS) - (06/04)
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