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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334803849
Report Date: 08/27/2024
Date Signed: 08/27/2024 04:02:58 PM

Document Has Been Signed on 08/27/2024 04:02 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:JUSD/VAN BUREN ELEMENTARYFACILITY NUMBER:
334803849
ADMINISTRATOR/
DIRECTOR:		KATRINA BROOKSFACILITY TYPE:
850
ADDRESS:9501 JURUPA ROADTELEPHONE:
(951) 222-7850
CITY:JURUPA VALLEYSTATE: CAZIP CODE:
91752
CAPACITY: 24TOTAL ENROLLED CHILDREN: 32CENSUS: 16DATE:
08/27/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:20 PM
MET WITH:Lead Teacher Kristy Ulloa and Director Natalie ValleTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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On 08/27/2024 at 12:20 PM Licensing Program Analyst (LPA) Susan Brewer, arrived at the facility to conduct a 1 year required annual inspection. LPA was granted entry by Lead Teacher Kristy Ulloa and Early Childhood Specialist Natalie Valle White. LPA toured the facility, inside and out, reviewed records, and observed and/or discussed the following:

Normal days and hours of operation are: Monday- Friday, 8:00 AM to 11:00 AM and 12:00 PM to 3:00 PM in Room F-1. Staff are present 7:30 AM to 11:30 PM and 11:30 PM to 4:00 PM.

The inspection consisted of reviews of the following domains: Food Service; Reporting Requirements
Physical Plant; Care and Supervision; Children Records; Staff Records; Staffing Ratio and Capacity and
Personal Rights. The inspection found the facility to be in compliance in these domains.

The licensee is asked to update the following documents, if applicable, and submit to licensing within 30 days, on or before 09/27/2024:
1. LIC 500 Personnel Report – Update requested.
2. LIC 610 Emergency & Disaster Plan – Update requested to include 2nd relocation site.
3. Parent Handbook/ Program Curriculum/Admission policies and procedures/ fee schedule (only if changes have been made)
4. LIC 309 Administrative Organization
5. LIC 308 Designation of Administrative Responsibility – Update requested.

The following items have been posted and are updated where necessary:
License, Emergency Disaster Plan (LIC610) and Earthquake Preparedness Checklist (LIC9148)
Parent’s Rights Poster (PUB393), Personal Rights (LIC613A); Child Car Seat Law, Menu
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE: DATE: 08/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/27/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: JUSD/VAN BUREN ELEMENTARY
FACILITY NUMBER: 334803849
VISIT DATE: 08/27/2024
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· The facility is operating within the terms of the license.
· Ratios were met and appropriate supervision was provided during this inspection. A census was taken of 16 children and 3 staff supervising.
· Classrooms are clean, free of hazards and equipped with age-appropriate furniture and equipment in good condition.
· No weapons stored at the facility on 08/27/2024.
· There are no accessible bodies of water present 08/27/2024. All wading pools or similar product must be emptied immediately after use and stored in an upright position.
· Medications are stored where inaccessible to children in the school’s health clerks office.
· Hazards are stored where inaccessible to children which include: Disinfectants, cleaners and other items that are dangerous. Poisons and toxins are locked in the storage closet.
· All floors are clean and safe.
· Bathrooms were observed to be safe, sanitary and in operating condition with 3 sinks and two toilets.
· Outdoor activity areas/playgrounds are enclosed by appropriate fences, free of hazards and are supplied with age and size appropriate equipment in good condition.
· Food preparation area is clean, free of litter, rubbish and free of rodents and other vermin.
· Measures are taken to keep the facility free of flies, other insects and rodents. The school maintenance department exterminates monthly.
· Food is stored appropriately and protected from contamination: The meals are prepared by the school district on site and brought to classroom.
· Storage containers for solid waste, including moveable bins-have tight-fitting covers in good repair.
· Menus are posted at least one week in advance in a place visible by the child’s authorized. LPA discussed missing information regarding portions and type of milk, milk alternatives and/or other juices served and made available for public view, along with the menus. LPA observed the menus to dated and kept on file for 30 days and made available upon request.
· Uncontaminated drinking water shall be readily available both indoors and out and provided by tap water, water fountains and water dispensers, disposable cups.
· The areas around or under high climbing equipment, swings, slides, and similar equipment shall be cushioned with material that absorbs a fall: Facility has natural grass, rubber turf and a shaded patio.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2024
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: JUSD/VAN BUREN ELEMENTARY
FACILITY NUMBER: 334803849
VISIT DATE: 08/27/2024
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· Sign in/Sign out record was reviewed and meets regulation requirements: Hubb, iPin-wheel app. The parents use a QR code to sign children in and out of care.
· A Staff member is present with current Pediatric CPR/First Aid which expires on 03/03/2025
· Opening and closing staff member’s CPR/First Aid expires on 03/03/2025 for opener.
· Director completed Health and Safety, Training on Spring 1998 transcripts.
· Staff qualifications and files were reviewed and are complete on 08/27/2024.
· Staff have received on the job training for housekeeping, sanitation and universal health precautions
Licensee was informed the Department has inspection authority per Health and Safety Codes.
Licensee provided the Unusual Incident Reporting email: UnusualIncidentReportsDO09@dss.ca.gov
· Children files were reviewed and are complete on 08/27/2024.
· Documentation of fire & earthquake drills to be conducted every six months: Last drill on 08/22/2024 at 8:30 AM with 14 children and 3 staff present and lasted 5 minutes.
· Lead Testing: Report date 05/30/2024 no lead exceedances.
· AB2370 – Lead Exposure, day care facilities, effective January 1, 2019 – The bill requires that all Child Care Centers, operating in a building constructed before January 1, 2010, shall have their drinking water tested for excessive lead levels, on or after January 1, 2020, but no later than January 1, 2023. Child Care Centers must thereafter test their drinking water every five years after the date of the initial test.
· AB605 – Child day care facilities, birth to school-age license; Effective January 1, 2021
· AB2960 – Child care and development services, online portal – Effective June 20, 2022 - This bill requires the State Superintendent of Public Instruction (SSPI), within the California Department of Education (CDE), to develop and post on CDE's website a comprehensive child care and development services online portal for families and providers by June 30, 2022.

This facility provides Incidental Medical Services – IMS. LPA S. Brewer, did not review storage of medication and equipment/supplies, or review children’s, personnel, and administrative records. Per licensee representative Natalie Valle White, the facility does not have a client request for IMS services at this time. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm For CCCs: Incidental Medical Services (IMS) policy was discussed.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2024
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: JUSD/VAN BUREN ELEMENTARY
FACILITY NUMBER: 334803849
VISIT DATE: 08/27/2024
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Licensee Representative Natalie Valle White was reminded that all adults 18 and over working in the facility, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Childcare Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Deficiencies were not cited this visit.

Civil Penalties were not cited this visit.

A notice of site visit was given and must remain posted for 30 days. The LPA observed the licensee post the Notice of Site visit prior to exiting the facility.

Exit interview conducted and report was reviewed with the Early Childhood Specialist Natalie Valle White.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2024
LIC809 (FAS) - (06/04)
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