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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334805424
Report Date: 11/21/2023
Date Signed: 11/21/2023 11:27:45 AM


Document Has Been Signed on 11/21/2023 11:27 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 SE CC RO, 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: 37DATE:
11/21/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Sandra RivasTIME COMPLETED:
11:37 AM
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On today’s date and time stated Licensing Program Analysts (LPAs) Amber Shaw and Sumayya Habeebulla conducted a case management in response to the receipt of an unusual incident report submitted to the department by the facility on 11/09/2023. The UIR indicates the Child 1 (C1) suffered and injury which resulted in treatment needed by a medical professional. LPAs met with director Ms. Sandra Rivas to gather additional details surrounding the incident. The staff present for the incident was not present on the day of the visit. LPA interviewed staff over the phone. As per the interviews, when classroom was getting ready for snack time and clean up, C1 became upset during that time and threw herself down, hurting her arm. It was determined after the first initial physician visit that C1's arm was fractured. However, per the follow up visit, it was determined C1 pulled a ligament and there was no cause or concern per the physician.

There were no deficiencies sited at this time

An exit interview was conducted, and this report was reviewed with the Director Sandra Rivas. Appeal rights were discussed and provided during the exit interview.


A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Carlos MartinezTELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Amber ShawTELEPHONE: (951) 218-7031
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2023
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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