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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198011340
Report Date: 12/13/2024
Date Signed: 12/13/2024 03:19:51 PM

Document Has Been Signed on 12/13/2024 03:19 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
MONTEREY PARK CC RO, 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: 102CENSUS: 82DATE:
12/13/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:15 PM
MET WITH:Denise Maria, Site Supervisor TIME VISIT/
INSPECTION COMPLETED:
03:25 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 Denise Maria, who gave LPA a tour of the facility.

On 10/18/2024 an incident was self reported to the department within the required 24 hours. Per Incident reported On 10/17/2024 Child # 1 and # Child # 2 bumped heads causing read marks on their foreheads. Child # 1 was taken to the doctor by parents.

On 12/09/2024 an incident was self reported to the department within the required 24 hours. Per Incident reported Child # 3 woke up from nap with a swollen face and hives on arms. Child was transported to the hospital.

LPA conducted interviews with staff, regarding incident # 1 & # 2. Incident # 1 was observed- child # 1 and child # 2 were running and bump heads causing a red mark on their foreheads. Ice was applied and followed head injury report. Child # 1 was taken to the doctor for precaution- child was cleared to come back with no restrictions.

Regarding incident # 2- Staff interviews disclosed that child # 3 woke up from nap with a puffy eyes, swollen lips and hives on both arms. Per Staff breakfast and lunch provided to child # 3 on that day were usual meals provided.
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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2024
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
MONTEREY PARK CC RO, 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: 12/13/2024
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Staff # 2 took pictures and sent them to the school nurse. Per Nurse instructions 911 was called- parent arrived at the facility and child was transported. Per SIte Supervisor- child # 3 is not clear to come back to school yet. Documentation was sent home to be filled out by the doctor.

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 Denise Maria.

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

DATE: 12/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2024
LIC809 (FAS) - (06/04)
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