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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364807708
Report Date: 01/18/2022
Date Signed: 01/18/2022 12:30:52 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 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:
01/18/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Irma CelayaTIME COMPLETED:
12:40 PM
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On 01/18/2021 at 11:45am Licensing Program Analysts (LPA) Justin Giese conducted a subsequent 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.

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 Child #1 arrived at the facility and claimed to have witnessed a staff member hit Child #1 on the hand through the front window of the facility. The parent/guardian's observations were immediately brought to the attention of the facility staff and the Administration for Early Education for the Rialto Unified School District.

On, November 30, 2021 LPA made an unannounced visit to the facility and conducted interviews with Facility Staff and children in care. Statements from individuals Interviewed and information obtained during/after the visit do not corroborate or support the the information provided in the UIR. Based on LPA's observations, interviews and information obtained, there appeared to be no violation of Title 22 Regulations pertaining to the reported incident.

An exit interview was conducted, LPA reviewed this report with Site Teacher, Irma Celaya. A copy of this report and notice of site visit were provided. Notice of site visit must be displayed in a prominent location for the next 30 days.

No deficiencies were cited. A copy of this report must be made available for the next three years.
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Justin GieseTELEPHONE: (951) 204-4847
LICENSING EVALUATOR SIGNATURE:

DATE: 01/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2022
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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