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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334808323
Report Date: 09/12/2024
Date Signed: 09/12/2024 12:15:41 PM

Document Has Been Signed on 09/12/2024 12:15 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:PSUSD - CATHEDRAL CITY ELEMENTARY SCHOOLFACILITY NUMBER:
334808323
ADMINISTRATOR/
DIRECTOR:		CATHERINE MALLORYFACILITY TYPE:
850
ADDRESS:69300 CONVERSE ROADTELEPHONE:
(760) 770-8585
CITY:CATHEDRAL CITYSTATE: CAZIP CODE:
92234
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 27DATE:
09/12/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:20 AM
MET WITH:Teacher/Site Supervisor Angelica Silva and ECE Coordinator Veronica MartinezTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Samuel Lopez arrived at the facility to conduct a case management visit in response to the receipt of an unusual incident report (UIR). The UIR was received by the licensing agency on 9/6/2024. The UIR documented an incident that occurred on 9/5/2024 on the playground, at the facility.

Prior to conducting the visit, LPA Lopez obtained additional information regarding the incident. Upon arrival this date on 9/12/2024, LPA Lopez met with Teacher/Site Supervisor Angelica Silva and ECE Coordinator Veronica Martinez and stated the purpose of the visit. Records were reviewed, documentation was obtained, and interview was conducted.

Based on the information obtained, a child was climbing down the leaf shaped stairs on the play structure. In climbing down, the child missed a step, causing the child to fall on to the ground and injure themselves. Staff responded and provided first aid to the child. Parents of the child were notified and injury report was completed and also provided. At the time of the incident, the group size consisted of 13 children and two staff, which was within teacher/child ratio.

A tour of the playground was conducted, along with an inspection of the structure, and the surrounding area. The structure and steps were observed to be in good repair during the inspection. The material underneath the structure is a combination of turf and rubber mating which can absorb a fall.

Based on the information gathered, facility complied with reporting requirements, and other regulation requirements. No violations of Title 22 were identified, at this time.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door 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 Teacher/Site Supervisor Angelica Silva and ECE Coordinator Veronica Martinez

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Samuel Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 09/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/12/2024
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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