<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364807708
Report Date: 11/30/2021
Date Signed: 11/30/2021 10:29:04 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:RIALTO U.S.D. HENRY ELEMENTARY SCHOOLFACILITY NUMBER:
364807708
ADMINISTRATOR:PATRICIA KRIZEKFACILITY TYPE:
850
ADDRESS:470 E. ETIWANDA AVENUETELEPHONE:
(909) 820-7910
CITY:RIALTOSTATE: CAZIP CODE:
92376
CAPACITY:24CENSUS: 17DATE:
11/30/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Irma CelayaTIME COMPLETED:
10:45 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 11/30/2021 at 8:45am Licensing Program Analysts (LPA) Justin Giese conducted an unannounced visit to the facility to follow up on the submission of an Unusual Incident Report (UIR) that was received by the Regional Office on 11/17/2021. LPA met with Site Teacher, Irma Celaya to discuss the purpose of the visit. LPA took census, reviewed records, toured the facility and conducted interviews with staff and children involved.

On November 17, 2021 Facility staff self reported an incident that occurred at the facility on November 16, 2021. UIR stated that around 11:00am a parent/guardian of a child in attendance arrived at the facility and witnessed a facility staff member hit their child on the hand through the front window of the facility. The observation was immediately brought to the attention of facility staff and the Administration for Early Education for the Rialto Unified School District.

Due to insufficient information available currently, LPA will return to the facility on a later date to conclude the investigation into this incident.

An exit interview was conducted, LPA Giese provided Site Teacher with a copy of this report and a notice of site vist on 11/30/2021.

Notice of site visit must be dispayed for the next 30 days.
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Justin GieseTELEPHONE: (951) 204-4847
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2021
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 1