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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103801352
Report Date: 10/28/2021
Date Signed: 10/28/2021 12:37:08 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:RIVERDALE U.S.D.PRESCHOOL/CENTRAL VALLEY PRESCHOOLFACILITY NUMBER:
103801352
ADMINISTRATOR:PERCELL, JEFFFACILITY TYPE:
850
ADDRESS:21320 SOUTH FELANDTELEPHONE:
(559) 867-0707
CITY:RIVERDALESTATE: CAZIP CODE:
93656
CAPACITY:57CENSUS: 0DATE:
10/28/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Kimberly RoushTIME COMPLETED:
12:55 PM
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On 10/28/2021, Licensing Program Analyst (LPA) Ocegueda conducted an unannounced case management inspection for the purposes of amending a report that was completed at the facility on 10/21/2021. Before entering the facility, LPA conducted a Covid-19 safety screening and met with Director Kimberly Roush. LPA explained the reason for today's inspection.

Today, LPA was not able to amend the report due to technical problems. LPA reviewed with Director that the type B deficiency cited for ratios under Title 22 and the California Code of Regulations 101216.3 would be removed as it was incorrectly cited. The facility was following and in compliance with title 5 ratio requirements on the date of the inspection which was correct for this facility.

Due to technical problems today, LPA will amend the report and send a copy for Director to sign and return to the Department. Director will keep a copy of the amended report for their facility records.

Exit interview was conducted with Kimberly Roush.

Per Chapter 1, Division 12, Title 22 of the California Code of Regulations no deficiencies were observed today. Site Visit Notice was posted on the parent board.
SUPERVISOR'S NAME: Michael DuarteTELEPHONE: (559) 650-7874
LICENSING EVALUATOR NAME: Ruby OceguedaTELEPHONE: (559) 341-5808
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
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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