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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
364842359
Report Date:
02/12/2020
Date Signed:
02/12/2020 03:38:16 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. KORDYAK ELEMENTARY SCHOOL
FACILITY NUMBER:
364842359
ADMINISTRATOR:
KRIZEK, PATRICIA
FACILITY TYPE:
850
ADDRESS:
4580 MANGO AVENUE
TELEPHONE:
9094214201
CITY:
FONTANA
STATE:
CA
ZIP CODE:
92336
CAPACITY:
54
CENSUS:
18
DATE:
02/12/2020
TYPE OF VISIT:
Case Management - Incident
UNANNOUNCED
TIME BEGAN:
01:00 PM
MET WITH:
Ms. Good Director & Ms. Bogarin with Early Ed.
TIME COMPLETED:
03:00 PM
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Licensing Program Analyst D. Brasel arrived at the facility on the above noted date and time to conduct a case management visit in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on 12/12/19.
LPA signed in with the school site office an proceeded to classroom D112. LPA observed 18 children with 3 staff.
Facility records were reviewed and interviews conducted. LPA contacted the Director Karen Good with the Early Ed Department. LPA requested further information for the incident reported. Once the additional information has been obtained and reviewed it will then be determined if a Title 22 violation occurred. A return visit will be conducted only for this incident if it is determined a violation occurred.
Ms. Good and Ms. Bogarin from Early Ed arrived at the site with needed documents.
An exit interview was conducted and a copy of this report was provided to Ms. Good and Ms. Bogarin on this date.
SUPERVISOR'S NAME:
Gilbert Sena
TELEPHONE:
(951) 782-4844
LICENSING EVALUATOR NAME:
Diana Brasel
TELEPHONE:
951-782-4952
LICENSING EVALUATOR SIGNATURE:
DATE:
02/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
02/12/2020
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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