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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334840454
Report Date: 06/09/2026
Date Signed: 06/09/2026 12:52:41 PM

Document Has Been Signed on 06/09/2026 12:52 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/
DIRECTOR:		ANDREA RODICH-VITECKFACILITY TYPE:
850
ADDRESS:16820 VIA PAMPLONA DRIVETELEPHONE:
(951) 940-8530
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92551
CAPACITY: 390TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
06/09/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:20 AM
MET WITH:Rosaura NavarroTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
NARRATIVE
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On the date and time, Licensing Program Analyst (LPA) Sumayya Habeebulla arrived at the VVUSD El Potrero (CCC) to conduct a case management visit regarding an incident reported to the department on May 7th, 2026 via the duty line.

LPA spoke with Ms. Rosaura Navarro who is the Site secretary for the Childcare program. The school was not in session and was closed for summer. The interview revealed that child #1 was in classroom #4 and after lunch child #1 ran out of the classroom. Staff #2 followed child #1 but was unable to observe where the child had headed to. Staff #2 reported the incident to Ms. Navarro and continued the search along with Staff #3. The staff were able to locate the child in the restroom that was located next to classroom 4. Child returned to the classroom and parents were notified by the facility director.

Facility was unable to provide LPA with a copy of the UIR. LPA had not received the UIR from the facility at the department.

As per the interviews and documentation recorded by the duty officer, child #1’s whereabouts were not known for approximately few minutes. This is a repeat violation of supervision.

See LIC 809-D for cited deficiencies.

NAME OF LICENSING PROGRAM MANAGER: Carlos Martinez
NAME OF LICENSING PROGRAM ANALYST: Sumayya Habeebulla
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/09/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 06/09/2026 12:52 PM - It Cannot Be Edited


Created By: Sumayya Habeebulla On 06/09/2026 at 12:19 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: 06/09/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/15/2026
Section Cited
CCR
101229(a)(1)

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(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time... Supervision shall include visual observation
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Licensee agrees to schedule a training for active supervision for all staff and create a new revised plan implemented for visual supervision and submit it to the department by the POC due date.
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This requirement is not met as evidenced by: Based on the interview the facility did not comply with the section in ensuring all children in care were under the direct supervision of a staff member. >>>
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>>>Child #1 left the classroom without staff supervision and whereabouts of child #1 was unknown for a few minutes.

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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.
Carlos Martinez
NAME OF LICENSING PROGRAM MANAGER:
Sumayya Habeebulla
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/09/2026


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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: VVUSD EL POTRERO PRESCHOOL
FACILITY NUMBER: 334840454
VISIT DATE: 06/09/2026
NARRATIVE
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LPA Habeebulla informed facility representative Rosaura Navarro that this report dated 06/09/26 documents one Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Habeebulla informed the facility representative Rosaura Navarro to provide a copy of this licensing report dated 06/09/26 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child’s file for verification.

An exit interview was held with Facility Representative Rosaura Navarro. A copy of this report was issued, along with a Notice of Site visit. This report shall be public record for three years.
NAME OF LICENSING PROGRAM MANAGER: Carlos Martinez
NAME OF LICENSING PROGRAM ANALYST: Sumayya Habeebulla
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2026
LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 06/09/2026 12:52 PM - It Cannot Be Edited


Created By: Sumayya Habeebulla On 06/09/2026 at 12:31 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: 06/09/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/16/2026
Section Cited
CCR
101212(d)(1)(C)

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101212(d)(1)(C) Reporting Requirements
(d) Upon the occurrence, during the operation...any of the events specified in (d)(1) below… (d)(2) below shall be submitted to the Department within seven days following... event.(1) Events reported ... unusual incident or ...health or safety of any child.
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Licensee agrees to submit a written statement of understanding of the reporting requirements regulation and ensure to submit an unusual incident report to the department within 7 days of occurrence.
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This requirement is not met as evidenced by: Based on the interview the facility did not submit LIC 624 to the department.
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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.
Carlos Martinez
NAME OF LICENSING PROGRAM MANAGER:
Sumayya Habeebulla
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 06/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/09/2026


LIC809 (FAS) - (06/04)
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