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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334805424
Report Date: 03/29/2021
Date Signed: 03/29/2021 02:40:01 PM

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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:RCCD MORENO VALLEY COLLEGE ECE CENTERFACILITY NUMBER:
334805424
ADMINISTRATOR:SANDRA RIVASFACILITY TYPE:
850
ADDRESS:16130 LASSELLE STREETTELEPHONE:
(951) 571-6214
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92551
CAPACITY:63CENSUS: 28DATE:
03/29/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:38 AM
MET WITH:Sandra Rivas-DirectorTIME COMPLETED:
11:40 AM
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A case management Tele-Visit is being conducted in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on 3/19/2021. It indicated child 1 was flipping on the carpet in the Bears Classroom on 3/12/2021 and was instructed by the Lead Teacher 2-3 times to stop flipping. As the teacher got the child situated and the child stopped flipping for a moment, the teacher began to assist another child in tying their shoe, C1 flipped again as the teacher turned to assist the other child and this time did a cart wheel using 1 hand.C1 began to say ouch as the child was hurt from this last flip.

Facility records were reviewed via email. Based on information gathered, the facility acted appropriately and no violations have been identified. Lead Teacher immediately attended to C1 with an ice pack and had him sit while contacting the parent. Facility also submitted the incident to Licensing timely.

An exit interview was conducted and a copy of this report was provided via email to facility Director Sandra Rivas.

SUPERVISOR'S NAME: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Lakesha EdwardsTELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2021
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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