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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364820584
Report Date: 10/11/2023
Date Signed: 10/11/2023 12:54:17 PM

Document Has Been Signed on 10/11/2023 12:54 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:RIALTO U.S.D.CHARLOTTE WERNER ELEMENTARY SCHOOLFACILITY NUMBER:
364820584
ADMINISTRATOR:GOOD, KARENFACILITY TYPE:
850
ADDRESS:1050 W. RIALTO AVENUETELEPHONE:
(909) 820-6830
CITY:RIALTOSTATE: CAZIP CODE:
92376
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 13DATE:
10/11/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Lead Teacher Lourdes ButmanTIME COMPLETED:
01:00 PM
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On this date and time, Licensing Program Analyst (LPA) Laura Mejorado 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 Riverside Child Care Regional office. The UIR documented an incident regarding an alleged personal rights violation.

Upon arrival, LPA met with Lead Teacher Lourdes Butman and stated the purpose of the visit. Records were reviewed and interviews were conducted. The subject child(ren) who was the subject of the UIR was present and also interviewed at the time of visit.

Based on the information gathered and compiled during this visit no citations were issued, at this time.

Exit interview conducted and report was reviewed with Lead Teacher Lourdes Butman.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Laura Mejorado
LICENSING EVALUATOR SIGNATURE: DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/11/2023
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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