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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845704
Report Date: 08/24/2026
Date Signed: 08/24/2026 01:44:33 PM

Document Has Been Signed on 08/24/2026 01:44 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 SKY COUNTRY ELEMENTARY PRESCHOOLFACILITY NUMBER:
334845704
ADMINISTRATOR/
DIRECTOR:		TRACI PAYOFACILITY TYPE:
850
ADDRESS:5520 LUCRETIA AVENUETELEPHONE:
(951) 222-7850
CITY:JURUPA VALLEYSTATE: CAZIP CODE:
91752
CAPACITY: 48TOTAL ENROLLED CHILDREN: 31CENSUS: 23DATE:
08/24/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Stephanie Martinez, facility representative TIME VISIT/
INSPECTION COMPLETED:
02:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Aman Lama arrived at the facility to conduct a case management visit in response to the receipt of an Unusual Incident Report (UIR). The UIR was received by the licensing agency on 08/24/2026. The UIR documented that on Friday, 08/21/2026, Maintenance informed them that the preschool restroom had to be closed due to the toilets backing up. The preschool playground restrooms were also affected. Due to the restroom closures, preschool classrooms will need to utilize the restrooms located in the Kindergarten classrooms. The facility is currently awaiting confirmation of repair timeline.

Upon arrival, LPA Lama met with the facility representative, Stephanie Martinez, and stated the purpose of the visit. LPA toured classrooms 26, 27, and 28. LPA also observed a staff take a child from classroom 28 to the Kindergarten classroom, who were on lunch at the time and not in the classrooms.

Although facility representative was able to submit a waiver letter during the time LPA was present at the facility, the preschool classrooms had already utilized the Kindergarten classrooms for restroom use. Due to this, there was a violation of Title 22 Regulations, and the facility is being cited for the following:

101161(a) Limitations on Capacity: A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation.


A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with facility representative, Stephanie Martinez.

Gilbert Sena
Aman Lama
DATE: 08/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/24/2026
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 08/24/2026 01:44 PM - It Cannot Be Edited


Created By: Aman Lama On 08/24/2026 at 01:24 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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: JUSD SKY COUNTRY ELEMENTARY PRESCHOOL
FACILITY NUMBER: 334845704

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/24/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/26/2026
Section Cited
CCR
101161(a)

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101161(a)LIMITATIONS ON CAPACITY:
A licensee shall not operate a child care center beyond the conditions and limitations specified on the license, including the capacity limitation. This was not met as evidenced by: The preschool classrooms were observed utilizing the kindergarten
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The facility agrees to submit a waiver request, complete with a schedule and facility sketch of the school, in relation to the preschool classrooms and kinder classroom. Specifically, the classroom utilized by the preschool program for restroom use.
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restrooms. Facility representative, Katrina Brooks was able to submit a waiver letter during the time LPA was present at the facility. LPA observed the preschool classrooms had utilized the Kindergarten classrooms for restroom use. The center did not submit a waiver request before utilizing
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the Kindergarten restrooms. This poses a potential risk to the health and safety of 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.
Gilbert Sena
NAME OF LICENSING PROGRAM MANAGER:
Aman Lama
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/24/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/24/2026


LIC809 (FAS) - (06/04)
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