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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334841934
Report Date: 02/15/2022
Date Signed: 02/15/2022 02:10:17 PM

Document Has Been Signed on 02/15/2022 02:10 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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:FSA-RUBIDOUX CDCFACILITY NUMBER:
334841934
ADMINISTRATOR:CASTRO, GRACIELAFACILITY TYPE:
850
ADDRESS:3865 RIVERVIEW DRIVETELEPHONE:
(951) 680-0312
CITY:JURUPA VALLEYSTATE: CAZIP CODE:
92509
CAPACITY: 144TOTAL ENROLLED CHILDREN: 144CENSUS: 52DATE:
02/15/2022
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Martha Castillo, Assistant DirectorTIME COMPLETED:
02:15 PM
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Due to COVID-19, On 02/15/2022 Licensing Program Analyst (LPA), Giselle Carbullido conducted a Case Management inspection to provide technical assistance. Several cohorts were temporarily closed in January 2022 due to COVID 19 and have recently reopened on various dates throughout January 2022 depending on when cohort was initially closed. LPA Carbullido met with Assistant Director, Martha Castillo ; toured the facility and took a census.

During the inspection, LPA reviewed and discussed COVID-19 guidelines, resources, and postings with Assistant Director. At 1:25PM LPA observed screen station and COVID posters at front entry, staff fully masked and classroom posters for hand washing, and cough and sneeze etiquettes. Also COVID-19 information posters including hand-washing posters were observed in child care areas and bathroom. The Facility representative was advised to follow the child care industry guidelines on face coverings, sanitation and other infection prevention measures.

During today’s inspection the following resources were discussed and provided:
· Community Care Licensing Division’s COVID 19 Information and Resources: https://www.cdss.ca.gov/inforesources/community-care-licensing

· CDPH’s Guidance for Child Care Providers and Programs - updated June 29, 2021: www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/Child-Care-Guidance.aspx

· Cal-OSHA - revisions are effective starting on January 17, 2022: https://www.dir.ca.gov/dosh/coronavirus/ETS.html
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: FSA-RUBIDOUX CDC
FACILITY NUMBER: 334841934
VISIT DATE: 02/15/2022
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1)California Department of Public Health
a. Guidance for Face Coverings
i. Released on July 28, 2021; Updated February, 7, 2022
b. https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/guidance-for-face-coverings.aspx

2) https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/Face-Coverings-QA.aspx

· Local Public Health Information:
· Riverside County Public Health:
Tel: (951) 358-5000
Website: https://www.rivcoph.org/

· Local Resource and Referral Agencies:
§ Riverside County Office of Education (RCOE):
Tel: (800) 442-4927
Website: https://www.rcoe.us/departments/early-learning-services/early-care-and-education

§ Child Care Resource Center (CCRC):
Tel: (909) 384-8000
Website: https://www.ccrcca.org/

· To report an Unusual Incident Report (UIR), please fax/scan a completed UIR form (within 24 hours of incident occurring), to the Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO09@dss.ca.gov or fax to 951-782-4985.

· FORMS: LIC624 (Child Care Center).

· You may also contact the Duty Officer at 951-782-4200
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2022
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: FSA-RUBIDOUX CDC
FACILITY NUMBER: 334841934
VISIT DATE: 02/15/2022
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· In addition, Provider Information Notices (PINs) and other resources regarding COVID-19 can be found on our website at: www.cdss.ca.gov

No deficiency was cited during this inspection.

An exit interview was conducted with Assistant Director Martha Castillo. LPA provided Assistant Director with a California Department of Public Health (CDPH) Childcare Guidance; CDPH face covering guidance; a copy of this report and a Notice of Site Visit.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2022
LIC809 (FAS) - (06/04)
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