<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334842375
Report Date: 04/17/2024
Date Signed: 04/17/2024 11:49:37 AM

Document Has Been Signed on 04/17/2024 11:49 AM - 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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:VVUSD MEAD VALLEY ELEMENTARYFACILITY NUMBER:
334842375
ADMINISTRATOR/
DIRECTOR:		ANDREA RODICH-VITEKFACILITY TYPE:
850
ADDRESS:21100 OLEANDER AVENUETELEPHONE:
(951) 940-8530
CITY:PERRISSTATE: CAZIP CODE:
92570
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 40DATE:
04/17/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:05 AM
MET WITH:Terri Villareal TIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPAs) Sumayya Habeebulla and Kelli Waters arrived at the facility for the purpose of conducting a case management visit. The Department received an unusual incident report (UIR) dated 03/20/24 from the facility stating a child was left unattended without supervision for a period of time during operational hours.

LPAs conducted interviews with pertaining parties, and it was found that Child 1 had been left alone inside Room #5 which has 3 restroom stalls. Room # 6 and Room #7 take turns using the restroom after recess. On the day of the incident, Room 6 used the restrooms first followed by Room 7 at approximately 9:30 AM. After Room 6 left, Room 7 began using the restroom stalls. Staff 2, and Staff 4 left the classroom with majority of the children and Staff 3 was waiting with the remaining 4 children to finish. As per Staff 3, they joined the class as they walked out the ramp towards their classroom. Staff and students of Room # 7 returned to the classroom and resumed their schedule, during which period Staff 1 entered the classroom with Child 1 stating the child was left alone in the restroom. Staff 1 heard a child crying and noticed Child 1 at the door of Room #5 unattended. Staff of Room #7 were not aware of the missing child.

C1 does not attend the facility anymore due to the incident and the last day of attendance was of 03/18/24.

From the information received by interviews with staff, and eyewitness, the facility is being cited for violation of the California Code of Regulations Title 22 Section 101229(a)(1) Responsibility for Providing Care and Supervision



See LIC 809D for deficiencies cited.

An exit interview was conducted with the Facility Representative Ms. Terri Villareal, a Notice of Site Visit posted, and a copy of this report was provided to the facility on this date and time.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE: DATE: 04/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/17/2024
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
Document Has Been Signed on 04/29/2024 09:47 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 04/22/2024 09:30 AM


Created By: Sumayya Habeebulla On 04/17/2024 at 11:25 AM
Link to Parent Document Below:
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 STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: VVUSD MEAD VALLEY ELEMENTARY
FACILITY NUMBER: 334842375

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/18/2024
Section Cited
CCR
101229(a)(1)

1
2
3
4
5
6
7
Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary...(1) No child(ren) shall be left without the supervision of a teacher at any time... Supervision shall include visual ...
1
2
3
4
5
6
7
The Facility Director agrees to review Title 22 section with staff and retrain staff on the Responsibility for Providing Care and Supervision. The Director will provide a written statement of understanding/compliance to the Department by the due date.
8
9
10
11
12
13
14
This requirement was not met as evidenced by: Based on interviews during transition time from the restroom to the classroom, a child was left behind at the restroom and the staff was not aware of the missing child until another teacher found the child and brought it to their attention.
8
9
10
11
12
13
14
Director will provide LIC 9224 to all parents enrolled for a period of one year and keep a copy in the child's file for review by the Department.

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Carlos Martinez
LICENSING EVALUATOR NAME:Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE:
DATE: 04/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/17/2024


LIC809 (FAS) - (06/04)
Page: 2 of 2