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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364807712
Report Date: 05/16/2022
Date Signed: 05/16/2022 10:41:38 AM


Document Has Been Signed on 05/16/2022 10:41 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501



FACILITY NAME:RIALTO U.S.D. TRAPP ELEMENTARY SCHOOLFACILITY NUMBER:
364807712
ADMINISTRATOR:GOOD, KARENFACILITY TYPE:
850
ADDRESS:2750 N. RIVERSIDE AVE.TELEPHONE:
(909) 820-7912
CITY:RIALTOSTATE: CAZIP CODE:
92377
CAPACITY:24CENSUS: 20DATE:
05/16/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Alexis BogarinTIME COMPLETED:
10:50 AM
NARRATIVE
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On 05/16/2022 at time listed above Licensing Program Analysts (LPA) Justin Giese conducted an unannounced visit to the facility for the purpose of following up on the submission of an Unusual Incident Report (UIR) that was received by the Regional Office on 05/05/2022. LPA met with Child Development Administrator, Alexis Bogarin to discuss the purpose of the visit.

On 05/05/2022 Facility Administration self reported an incident that occurred at the facility on 05/04/2022. UIR stated that around 11:30am staff transitioned children to the school's cafeteria for lunch. UIR stated staff conducted multiple headcounts but failed to account for a child that was left behind in the classroom's bathroom. After staff left the classroom and transitioned to the cafeteria, the child was left without supervision. UIR stated The child exited the classroom's back door and made their way on the playground. According to the UIR, the child was observed on the playground by a Parent/Guardian dropping off their child. Once notified, facility staff responded quickly and the child was immediately returned to their teachers and joined their classmates in the cafeteria. UIR stated the Child's Parent/Guardian was immediately contacted about this incident. Along with the submitted UIR, Facility Administration included written statements from staff involved as well as a plan of action to correct and prevent this type incident from occurring again in the future.

The facility was found to be in violation of the following Title 22 regulation:

101229(a)(1) Responsibility for Providing Care and Supervision
(a) The licensee shall provide care and supervision as necessary to meet the children's needs.
(1) No child(ren) shall be left without the supervision of a teacher at any time... Supervision shall include visual observation.
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Justin GieseTELEPHONE: (951) 204-4847
LICENSING EVALUATOR SIGNATURE:
DATE: 05/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/16/2022
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 3


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: RIALTO U.S.D. TRAPP ELEMENTARY SCHOOL
FACILITY NUMBER: 364807712
VISIT DATE: 05/16/2022
NARRATIVE
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See LIC809D for cited Type A deficiency

LPA issued a Notice of Site Visit and verified it was posted in a prominent location at the facility. Facility Administration understands that the Notice of Site Visit must remain posted for the next 30 days along with a copy of all Type A deficiencies cited during this inspection. A copy of all Type A deficiencies cited during this inspection must also be immediately (within 24 hours of child’s next day in care) given to the parents of all children enrolled in the child care facility and any children enrolled into the child care facility over the next 12 months (at the time of enrollment). Facility Administration is required to have all parents sign and date the Acknowledgement of Receipt of Licensing Reports (LIC9224) and maintain a copy in each child’s file.

A copy of this report, LIC9224 and Appeal Rights (LIC9058) were provided during this inspection.

Exit interview conducted and report was reviewed with the Facility representative, Alexis Bogarin.

A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Justin GieseTELEPHONE: (951) 204-4847
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 05/16/2022 10:41 AM - It Cannot Be Edited

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: RIALTO U.S.D. TRAPP ELEMENTARY SCHOOL
FACILITY NUMBER: 364807712

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/16/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/16/2022
Section Cited

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Responsibility for Providing Care and Supervision: (a) The licensee shall provide care and supervision to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time... Supervision shall include visual observation.
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Based on observation and records reviewed, facility staff failed to provide proper care and supervision for a child that was left behind in their classroom while transitioning others to the school's cafeteria. This poses an immediate health, safety and personal rights risk to children in care.
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Facility Administration has submitted a written plan of action to Licensing outlining steps the facility will take to account for children while transitioning from the classroom.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Justin GieseTELEPHONE: (951) 204-4847
LICENSING EVALUATOR SIGNATURE:
DATE: 05/16/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/16/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3