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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334820663
Report Date: 08/06/2021
Date Signed: 08/06/2021 10:26:00 AM

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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:RUSD/JACKSON ELEMENTARY SCHOOLFACILITY NUMBER:
334820663
ADMINISTRATOR:JOLYNN BARNESFACILITY TYPE:
850
ADDRESS:4585 JACKSON STREETTELEPHONE:
(951) 352-8211
CITY:RIVERSIDESTATE: CAZIP CODE:
92503
CAPACITY:24CENSUS: 0DATE:
08/06/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Luz Romero-TIME COMPLETED:
10:30 AM
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On 8/6/2021, Licensing Program Analyst (LPA) Andrea Taylor conducted a Case Management inspection due to a request for a classroom change. During today's inspection, LPA Taylor met with Luz Romero (Early Childhood Services Specialist), which provided access to the campus and classroom. A request for room change was received on 7/29/2020 and a Fire Clearance was granted on 8/4/2021. The Preschool Program is being moved to Room 5 from Room 2, without a capacity change.

***Please note that at there are no children currently in attendance due to school not beginning until 8/9/21***

Preschool (Room 5) Indoor Activity Area
LPA has determined that there is sufficient space to accommodate only 22 children not the 24 requested.

Preschool Bathroom Fixtures
7 Toilets x 15 = 45 children
7 Sinks x 15 = 45 children (1 inside the classroom and the other 2 in the each restroom)
***Please note: 6 toilets, and 6 sinks are in the restrooms that are located outside of the classroom. There is a waiver for the Preschool children to share restrooms with the Elementary School children***

Preschool Outdoor Activity Area
LPA has determined that there is sufficient space to accommodate 24 children.

Limiting factor for preschool capacity is the square footage of the classroom. Preschool capacity is limited to 22 children.

A notice of site visit was issued and is to be posted in a prominent location at the facility for the next 30 days. No deficiencies observed/cited during this inspection.

SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Andrea TaylorTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2021
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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