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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334820663
Report Date: 12/02/2021
Date Signed: 12/02/2021 11:31:21 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: 8DATE:
12/02/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH: Alejandra Gomez de GutierrezTIME COMPLETED:
11:40 AM
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On 12/2/2021, Licensing Program Analysts (LPAs) Samuel Lopez and Karrene Phillips conducted a Case Management inspection in order to verify that the classroom has sufficient square footage for the capacity on current license. Also, a new play structure was installed, on the facility playground, and will be inspected as well. During today's inspection, LPAs Lopez and Phillips met with Teacher Alejandra Gomez de Gutierrez, which provided access to the campus and classroom.

Preschool (Room P42) Indoor Activity Area
LPA has determined that there is sufficient space to accommodate 22 children.

Preschool Bathroom Fixtures
5 Toilets x 15 = 75 children
2 Urinal x 15 = 30 children
8 Sinks x 15 = 120 children

***Please note: 1 toilet and 2 sinks are located inside the classroom and the others are located outside, as part of the Elementary School however, there is a waiver on file for the Preschool children to share restrooms with the Elementary School children***

The play structure was inspected and the following was observed: The play structure is in good repair and has sufficient cushioning material (wood chips) in and around the drop zones, also underneath the entire structure.

Preschool Outdoor Activity Area
LPA has determined that there is sufficient space to accommodate the requested capacity.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Samuel LopezTELEPHONE: (951) 897-2482
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 SCHOOL
FACILITY NUMBER: 334820663
VISIT DATE: 12/02/2021
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LPA has determined that there is sufficient space to accommodate 22 children.

***Please note: The facility now has there own assigned playground however, there is still a pre-existing waiver for the Preschool children to share the playground with the Kindergarten children, even though the facility has their own playground.

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

No deficiencies observed/cited during this inspection.

Exit interview conducted and report was reviewed with Teacher, Alejandra Gomez de Gutierrez.

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

SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Samuel LopezTELEPHONE: (951) 897-2482
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2021
LIC809 (FAS) - (06/04)
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