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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334840454
Report Date: 09/16/2022
Date Signed: 09/16/2022 02:02:10 PM

Document Has Been Signed on 09/16/2022 02:02 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
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:VVUSD EL POTRERO PRESCHOOLFACILITY NUMBER:
334840454
ADMINISTRATOR:ANDREA RODICH-VITECKFACILITY TYPE:
850
ADDRESS:16820 VIA PAMPLONA DRIVETELEPHONE:
(951) 940-8530
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92551
CAPACITY: 390TOTAL ENROLLED CHILDREN: 390CENSUS: 53DATE:
09/16/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:17 PM
MET WITH:Rosaura Navarro TIME COMPLETED:
02:16 PM
NARRATIVE
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On September 16, 2022 at 12:17 PM, a case management visit is being conducted in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on 08/23/22. The UIR indicates that a child(C1) showed fear from a teacher(S1).

Facility records were reviewed and LPA conducted confidential interviews with staff and children. Based on the information gathered, the following violations have been identified: Based on interviews, record review and LPA observation, the facility is being cited for California Code of Regulations, Title 22, Div. 12; section 101223 (a) (1) Personal Rights.

An exit interview was conducted, LIC809D, (LIC811) Confidential Names, appeal rights discussed, and a copy of this report was provided to Principal Andrea Vitek-Rodich.

SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Anastasia Flores
LICENSING EVALUATOR SIGNATURE: DATE: 09/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/16/2022
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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Document Has Been Signed on 09/16/2022 02:02 PM - It Cannot Be Edited


Created By: Anastasia Flores On 09/16/2022 at 01:25 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: VVUSD EL POTRERO PRESCHOOL
FACILITY NUMBER: 334840454

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/16/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/23/2022
Section Cited
CCR
101223(a)(1)

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101223 (a) (1) Personal Rights; The licensee shall ensure that each child is accorded the following personal rights: To be accorded dignity in his/her personal relationships with staff and other persons.
This was not met as evidenced by...
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Princiipal/Director will have S1 attend the CPI training and S1 has been previously given a letter of reprimand this yer and a verbal warning last school year. Principal will observe the classroom while S1 is teaching and send LPA Flores a letter for plan of correction by 09/23/22.
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Based on LPA observation, record review and interviews with staff and children which poses/posed a potential health, safety or 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:Pauline Beschorner
LICENSING EVALUATOR NAME:Anastasia Flores
LICENSING EVALUATOR SIGNATURE:
DATE: 09/16/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/16/2022


LIC809 (FAS) - (06/04)
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