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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364813098
Report Date: 05/29/2024
Date Signed: 05/29/2024 12:05:46 PM

Document Has Been Signed on 05/29/2024 12:05 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:PSD - RIALTO EUCALYPTUS HEAD STARTFACILITY NUMBER:
364813098
ADMINISTRATOR/
DIRECTOR:		LUZ GONZALEZFACILITY TYPE:
850
ADDRESS:485 NORTH EUCALYPTUS AVENUETELEPHONE:
(909) 421-7180
CITY:RIALTOSTATE: CAZIP CODE:
92376
CAPACITY: 120TOTAL ENROLLED CHILDREN: 120CENSUS: 52DATE:
05/29/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Luz GonzalezTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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On 05/29/2024 at 8:45 AM, Licensing Program Analyst (LPA) Tiffanie Diep met with Site Supervisor Luz Gonzalez for the purpose of an unannounced case management inspection to follow up on an Unusual Incident Report (UIR) submitted to the Department on 05/10/2024. The incident was reported by the facility within the required timeframe. Site Supervisor guided LPA on a tour of the facility, and LPA observed 12 staff supervising 52 children.

All individuals subject to a criminal record review have obtained a criminal record clearance. Site Supervisor was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of five days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Continues on LIC 809-C
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE: DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/29/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: PSD - RIALTO EUCALYPTUS HEAD START
FACILITY NUMBER: 364813098
VISIT DATE: 05/29/2024
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Continued from LIC 809 (Page 2)

LPA made observations at the facility, obtained relevant documents, and conducted interviews with staff and day care children during today's visit. Information obtained revealed that a child (C1) sustained an injury when they were pushed by another child (C2) while fighting over a toy during outdoor play. Interviews conducted disclosed that staff immediately attended to C1 and contacted all relevant parties in a timely manner. It was revealed that staff took immediate action to prevent similar incidents from occurring in the future. It was also revealed that C1 has returned to the facility since the incident. Based on observations made at the facility, information obtained during interviews, and records reviewed, it is determined there were no violations pertaining to the incident.

There were no deficiencies cited at this time. An exit interview was conducted and report was reviewed with the site supervisor, Luz Gonzalez. 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.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024
LIC809 (FAS) - (06/04)
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