330910782-4-25-2024-09-CC-SMOA-D4NPGG-20240425111820

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 330910782
Report Date: 04/25/2024
Date Signed: 04/25/2024 11:18:27 AM

Document Has Been Signed on 04/25/2024 11:18 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME:	JUSD/RUSTIC LANE ELEMENTARY		FACILITY NUMBER:	330910782
ADMINISTRATOR/ DIRECTOR:	KATRINA BROOKS		FACILITY TYPE:	850
ADDRESS:	6420 RUSTIC LANE		TELEPHONE:	(951) 222-7850
CITY:	JURUPA VALLEY	STATE: CA	ZIP CODE:	92509
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 24	CENSUS: 16	DATE:	04/25/2024
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:37 AM
MET WITH:	Teacher Cory Bellenger		TIME VISIT/ INSPECTION COMPLETED:	11:27 AM

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On 4/25/24 at above time, Licensing Program Analyst (LPA) Steven Montoya arrived at the facility to conduct a 1 year required annual inspection. LPA was granted entry by Preschool Teacher, Corey Belleger. Later Early Childhood Specialist Cheryl Mitchel arrived to assist.. LPA toured the facility, inside and out, reviewed records and observed and/or discussed the following.

Days and hours of operation are Monday -Friday; 8-11:00AM and 12-3 PM

The inspection consisted of reviews of the following domains: Food Service; Reporting Requirements Physical Plant; Care and Supervision; Children Records; Staff Records; Staffing Ratio and Capacity and Personal Rights. The inspection found the facility to be in compliance in these domains, except as noted on the LIC809D. Deficiencies were not cited this visit.

The licensee is asked to update the following documents, if applicable, and submit to licensing within 30 days:

1. LIC 500 Personnel Report
2. LIC 610 Emergency & Disaster Plan
3. Parent Handbook/ Program Curriculum/Admission policies and procedures/ fee schedule (only if changes have been made)
4. LIC 309 Administrative Organization
5. LIC 308 Designation of Administrative Responsibility

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Steven Montoya
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024

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: JUSD/RUSTIC LANE ELEMENTARY	FACILITY NUMBER: 330910782
	VISIT DATE: 04/25/2024

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The following items have been posted and are updated where necessary:
License, Emergency Disaster Plan (LIC610) and Earthquake Preparedness Checklist (LIC9148)
Parent’s Rights Poster (PUB393), Personal Rights (LIC613A); Child Car Seat Law, Menu
· The facility is operating within the terms of the license.
· Ratios were met with appropriate supervision during this inspection

· Classrooms are clean, free of hazards and equipped with age appropriate furniture
· No weapons stored at the facility
· There are no accessible bodies of water present. All wading pools or similar product must be emptied immediately after use and stored in an upright position.
· Medications are stored inaccessible to children in the school front office
· Hazards are stored inaccessible to children which include: Disinfectants, cleaners and other items that are dangerous. Poisons and toxins are locked
· All floors are clean and safe.
· Bathrooms were observed to be safe, sanitary and in operating condition
· Outdoor activity areas/play grounds are enclosed by appropriate fences, free of hazards with age and size appropriate equipment in good condition: Yes
· Food preparation area is clean, free of litter, rubbish and free of rodents and other vermin
· Measures are taken to keep the facility free of flies, other insects and rodents
· Food is stored appropriately and protected from contamination
· Storage containers for solid waste, including moveable bins-have tight-fitting covers in good repair
· Menus are posted at least one week in advance in a place visible by the child’s authorized representative, dated and kept on file for 30 days, and made available upon request
· Uncontaminated drinking water shall be readily available both indoors and out.
· The areas around or under high climbing equipment, swings, slides, and similar equipment shall be cushioned with material that absorbs a fall: Facility has foam rubber matting

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Steven Montoya
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024

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: JUSD/RUSTIC LANE ELEMENTARY	FACILITY NUMBER: 330910782
	VISIT DATE: 04/25/2024

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Sign in/Sign out record was reviewed and meets regulation requirements: Yes
· A Staff member is present with current Pediatric CPR/First Aid. See LIC859
· Opening and closing staff member’s CPR/First Aid See LIC 859
· Teacher completed Health and Safety Training.
· Staff qualifications and files were reviewed and are complete. See LIC859
· Staff have received on the job training for housekeeping, sanitation and universal health precautions

Licensee was informed the Department has inspection authority per Health and Safety Codes.
Licensee provided the Unusual Incident Reporting email: UnusualIncidentReportsDO09@dss.ca.gov
· Children files were reviewed and are complete. Yes
· Documentation of fire & earthquake drills to be conducted every six months: Last drill on: 4-23-2024

- AB 1207 – Mandated Child Abuse Reporting: Child Day Care Personnel Training, beginning January 1, 2018 – Requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. District provided.

· AB605 – Child day care facilities, birth to school-age license; Effective January 1, 2021

· AB2960 – Child care and development services, online portal – Effective June 20, 2022 - This bill requires the State Superintendent of Public Instruction (SSPI), within the California Department of Education (CDE), to develop and post on CDE's website a comprehensive child care and development services online portal for families and providers by June 30, 2022.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Steven Montoya
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024

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: JUSD/RUSTIC LANE ELEMENTARY	FACILITY NUMBER: 330910782
	VISIT DATE: 04/25/2024

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The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm For CCCs: Incidental Medical Services (IMS) policy was discussed.

Site Teacher was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with Facility Representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Facility Representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

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

Exit interview conducted and report was reviewed with the Facility Representative, Katrina Brooks.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Steven Montoya
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024

LIC809 (FAS) - (06/04)

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