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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334816842
Report Date: 05/27/2022
Date Signed: 05/27/2022 09:44:20 AM

Document Has Been Signed on 05/27/2022 09:44 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:JUSD/GLEN AVON ELEMENTARYFACILITY NUMBER:
334816842
ADMINISTRATOR:SONIA PORTERFACILITY TYPE:
850
ADDRESS:4352 PYRITE STREETTELEPHONE:
(951) 360-2764
CITY:JURUPA VALLEYSTATE: CAZIP CODE:
92509
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 0DATE:
05/27/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Katrina Brooks, CoordinatorTIME COMPLETED:
09:50 AM
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Licensing Program Analyst (LPA), Giselle Carbullido arrived to inspect a facility (public school portable) on inactive status since 2017 for renovations. LPA met with ECE Coordinator Katrina Brooks. During the visit LPA inspected classroom and per the ECE Coordinator the portable will be used to accommodate Pre School Age children.

LPA observed the following: A fire clearance was granted for use of the room on July 12, 2006. Current capacity is based on fire clearance for 24. During this visit LPA observed:

The room is equipped with age appropriate furniture and the equipment is in good condition. LPA observed new built in cabinets and general updates- new blinds, paint etc.. No major renovations affecting size of portable. LPA remeasured and room still meets requirements for current capacity of 24.

- The floor and room appears to be clean, safe and free of hazards. - Hazards are stored where inaccessible to children which includes: disinfectants, cleaning solutions and other items that are dangerous to children. - Storage areas for poisons and toxins are locked in locked cabinet. - No medications are stored in classroom but will be stored in the health office - The facility has a functioning Carbon monoxide and smoke detectors that are hardwired and dual, monthly inspections for operation are conducted by the school district. Facility has indoor and outdoor water fountains.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE: DATE: 05/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/27/2022
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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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: JUSD/GLEN AVON ELEMENTARY
FACILITY NUMBER: 334816842
VISIT DATE: 05/27/2022
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Preschool room number 2 is in substantial compliance. CHILDREN SERVED Preschool ages 3-5.5 years. DAYS AND HOURS OF OPERATION: MONDAY THRU FRIDAY: 2 sessions 8:00AM-11:30AM and 12PM-3:30PM.

During the exit interview, a copy of this report and notice of site visit was provided to the ECE Coordinator, Katrina Brooks.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:

DATE: 05/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2022
LIC809 (FAS) - (06/04)
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