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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198011340
Report Date: 03/10/2025
Date Signed: 03/10/2025 01:11:51 PM

Document Has Been Signed on 03/10/2025 01:11 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: 150CENSUS: 73DATE:
03/10/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:20 AM
MET WITH:Elsa Gomez, Child Development SupervisorTIME VISIT/
INSPECTION COMPLETED:
01:20 PM
NARRATIVE
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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 incident that were self- reported to the department on 03/07/2025. LPA met with Child Development Site Supervisor Elsa Gomez, who gave LPA a tour of the facility.

On 3/7/2025 an incident was self reported to the department within the required 24 hours. Per Incident reported On 3/6/2025 Child # 1 slipped and fell on structure causing a cut on lip.Child # 1 was taken to the doctor by parents and needed stiches.

LPA conducted interviews with staff, and child # 2 regarding incident. Per staff incident occurred in the
steps on the front of the structure and was not observed by any staff. Staff # 1 was located on the back of structure helping children who were sliding down. Staff # 2 had a group of children in the puzzle area and staff # 3 had a group of children in the sandbox area. Staff # 2 heard child # 1 cry and observed them walking to Staff # 3- child had blood in their mouth and Staff # 2 administered first aid. Per staff child # 2 disclosed that child # 1 was running on the steps of structure and fell. LPA interviewed child # 2- child disclosed that child # 1 was running on structure and fell cutting their lip. Child # 2 disclosed that staff was present- staff # 1 was helping children on the slide and staff # 2 helped child # 1 "to feel better"


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SUPERVISORS NAME: Brandi VanOosten
LICENSING EVALUATOR NAME: Roxana Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 03/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2025
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: 03/10/2025
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 Interviews corroborated that ratio was met during the time of the incident- and that active supervision procedure was in placed. Staff 1-3 corroborated that there is a plan in place to only allow 8 children at a time on structure and provide other areas for children to use.

Children were reminded of safety
rules for outdoor play and structure area. Structure was checked for any damaged or lifted turf- cushioning that could have been damaged. LPA observed area to be safe of hazards.

Child # 2 was taken to the doctor- per mom child needed 10 stiches. Child # 2 is not back at school yet- facility will be meeting with parents to clear child to come back. Doctor notes were provided.

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.

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

DATE: 03/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2025
LIC809 (FAS) - (06/04)
Page: 2 of 2