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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 364817288
Report Date: 11/04/2019
Date Signed: 12/11/2019 03:09:23 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/28/2019 and conducted by Evaluator Destinee Hogue
PUBLIC
COMPLAINT CONTROL NUMBER: 09-CC-20190828111835
FACILITY NAME:RUSD-MENTONE ELEMENTARY SCHOOLFACILITY NUMBER:
364817288
ADMINISTRATOR:SUE BUSTERFACILITY TYPE:
850
ADDRESS:1320 CRAFTON AVENUE,K-1TELEPHONE:
(909) 794-8610
CITY:MENTONESTATE: CAZIP CODE:
92359
CAPACITY:24CENSUS: 18DATE:
11/04/2019
UNANNOUNCEDTIME BEGAN:
10:07 AM
MET WITH:Amy PryTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Admission Policies-Facility is operating beyond the scope of their license.
INVESTIGATION FINDINGS:
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***This is an amended report of the Complaint Investigation Report issued on 11/04/2019. Corrections were made to the deficiency issued as a result of the Substantiated findings.***

On 11/4/19 at 10:07am, Licensing Program Analyst (LPA) Destinee Hogue arrived at the facility to conduct an unannounced inspection to deliver the findings of the above allegations. An initial 10-day inspection was conducted by LPA Hogue on 9/5/19. During this inspection, LPA Hogue met with Site Administrator Amy Pry and discussed the following:

The following was alleged: Facility is operating beyond the scope of their license by enrolling a child under the age of three years.

Admission Policies: The facility’s policies must coincide with the limitations stated on the license, however the facility failed to notify the department of changes made to the plan of operation that affects the ages of >>>>>
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Destinee HogueTELEPHONE: (951) 218-5196
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 09-CC-20190828111835
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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-MENTONE ELEMENTARY SCHOOL
FACILITY NUMBER: 364817288
VISIT DATE: 11/04/2019
NARRATIVE
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>>>>>>>>> children being served. Beginning the 2019/2020 school year (8/7/19, first day of school) admission priorities for enrollment age range changed. Effective 2019/2020, Priority Enrollment: (A) Child Protective Service Referrals for three and four-year-old regardless of income. (B) Child who will be four years old on or before December 1, 2019 then Second Priority Enrollment: Children who will be three years old on or before December 1, 2019 (Birthdates 12/2/15 thru 12/1/16). LPA reviewed a random selection of children records on 09/05/2019 and found that the facility enrolled a child who is two years and nine months old. Facility updated LIC200A Application for a Child Care Center License on 09/05/2019 indicating age range of children served is three to five years old. On 9/5/19, LPA Hogue received an updated State Preschool Parent Handbook (Revised July 2019) which indicates on page two that second priority enrollment will be “children who will be three years old on or before December 1st of the current school year.”

RUSD-Mentone Elementary School is licensed to provide care to children ages three to five years, but enrolled a child outside of their approved licensed age range which is a violation of Title 22, Division 12, Chapter 1, Article 06 Continuing Requirements, 101218(a)(2) Admission Policies.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Destinee HogueTELEPHONE: (951) 218-5196
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2019
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 09-CC-20190828111835
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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-MENTONE ELEMENTARY SCHOOL
FACILITY NUMBER: 364817288
VISIT DATE: 11/04/2019
NARRATIVE
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THIS PAGE IS LEFT BLANK INTENTIONALLY.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Destinee HogueTELEPHONE: (951) 218-5196
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2019
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 09-CC-20190828111835
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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-MENTONE ELEMENTARY SCHOOL
FACILITY NUMBER: 364817288
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/04/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/05/2019
Section Cited
CCR
101223(a)(1)
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***This is an amended report of the Complaint Investigation Report issued on 11/04/2019. Additional information was obtained which changes the finding of Substantiated to Unsubstantiated. No deficiencies are being cited in reference to the 11/04/2019 report.**
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***This is an amended report of the Complaint Investigation Report issued on 11/04/2019. Additional information was obtained which changes the finding of Substantiated to Unsubstantiated. No deficiencies are being cited in reference to the 11/04/2019 report.**
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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: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Destinee HogueTELEPHONE: (951) 218-5196
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2019
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 09-CC-20190828111835
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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-MENTONE ELEMENTARY SCHOOL
FACILITY NUMBER: 364817288
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/04/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/12/2019
Section Cited
CCR
101218(a)(2)
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(a) Every child care center shall have all admission policies in writing...The policies shall coincide with the limitations stated on the license, and shall include...the following: (2) The ages of children who will be accepted.
This requirement was not met as evidenced by:
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Site Administrator agreed to submit an updated LIC200A, LIC308, LIC500 and Director's package to the department by 11/12/19. Documents may be sent via mail or in person delivery (original signatures required).
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Based on review of children records and updated LIC200A received 9/5/19, enrollment priorities for children in care were changed 08/07/2019. Facility is licensed to provide care to children ages three to five years, but enrolled a child outside of their approved licensed age range This poses a potential health, safety, and personal rights risk to children in care.
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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: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Destinee HogueTELEPHONE: (951) 218-5196
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2019
LIC9099 (FAS) - (06/04)
Page: 4 of 5