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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364820584
Report Date: 05/10/2024
Date Signed: 05/10/2024 02:05:13 PM

Document Has Been Signed on 05/10/2024 02:05 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:RIALTO U.S.D.CHARLOTTE WERNER ELEMENTARY SCHOOLFACILITY NUMBER:
364820584
ADMINISTRATOR/
DIRECTOR:		GOOD, KARENFACILITY TYPE:
850
ADDRESS:1050 W. RIALTO AVENUETELEPHONE:
(909) 820-6830
CITY:RIALTOSTATE: CAZIP CODE:
92376
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 19DATE:
05/10/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:05 PM
MET WITH:Lourdes ButmanTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
NARRATIVE
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On this date and time, Licensing Program Analysts (LPAs) Laura Mejorado and Tiffanie Diep, 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, on 04/29/24. The UIR documented an incident regarding supervision.

Upon arrival, LPAs met with the Lead Teacher Lourdes Butman and stated the purpose of the visit. Records were reviewed and interviews were conducted.

On 4/29/24 at 9:30am, while the children were transitioning from outside to inside the classroom, a child was left outside unattended. At 9:31am the child knocked on the door, and staff realized the child had been left outside. There was a total of 20 children and three staff present the date of the incident. UIR stated the Child's Parent/Guardian was immediately contacted about this incident. Along with the submitted UIR, Facility Administration included written statements from staff involved as well as a plan of action to correct and prevent this type of incident from occurring again in the future.


The facility was found to be in violation of the following Title 22 regulation:

101229(a)(1) Responsibility for Providing Care and Supervision
(a) The licensee shall provide care and supervision as necessary to meet the children's needs.
(1) No child(ren) shall be left without the supervision of a teacher at any time... Supervision shall include visual observation.

See LIC809D for cited Type A deficiency

SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Laura Mejorado
LICENSING EVALUATOR SIGNATURE: DATE: 05/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/10/2024
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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Document Has Been Signed on 05/10/2024 02:05 PM - It Cannot Be Edited


Created By: Laura Mejorado On 05/09/2024 at 04:57 PM
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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: RIALTO U.S.D.CHARLOTTE WERNER ELEMENTARY SCHOOL
FACILITY NUMBER: 364820584

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/10/2024
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision: (a) The licensee shall provide care and supervision to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time... Supervision shall include visual observation. This requirement is not met as evidenced by:
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Facility staff understands the importance of this regulation and the importance of providing adequate care and supervision of children in care at all times.
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Based on interviews and records reviewed, facility staff failed to provide proper care and supervision for a child that was left behind outside while transitioning others inside the classroom. This poses an immediate health, safety and personal rights risk to children in care.
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An action plan was submitted to CCL which includes staff conducting head counts when entering and exiting the class, and conducting a final walk through of the playground checking the tunnels and behind the water fountain, making sure all children are accounted.

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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:Ana Noble
LICENSING EVALUATOR NAME:Laura Mejorado
LICENSING EVALUATOR SIGNATURE:
DATE: 05/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/10/2024


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: RIALTO U.S.D.CHARLOTTE WERNER ELEMENTARY SCHOOL
FACILITY NUMBER: 364820584
VISIT DATE: 05/10/2024
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Upon receipt of this report, the Licensee shall post the Notice of Site Visit and any Licensing report documenting a type “A” deficiency. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement of Receipt (LIC 9224 form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC 9224).


A copy of this report and Appeal Rights (LIC9058) were provided during this inspection.

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: Ana Noble
LICENSING EVALUATOR NAME: Laura Mejorado
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2024
LIC809 (FAS) - (06/04)
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