334847012-8-10-2026-09-CC-DBRL-DWTR2P-20260810123839

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334847012
Report Date: 08/10/2026
Date Signed: 08/10/2026 12:38:57 PM

Document Has Been Signed on 08/10/2026 12:38 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 / CAMINO REAL ELEMENTARY		FACILITY NUMBER:	334847012
ADMINISTRATOR/ DIRECTOR:	BOWEN, LYNETTE		FACILITY TYPE:	860
ADDRESS:	4655 CAMINO REAL		TELEPHONE:	(951) 360-4100
CITY:	JURUPA VALLEY	STATE: CA	ZIP CODE:	92509
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 24	CENSUS: 0	DATE:	08/10/2026
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:50 AM
MET WITH:	Katrina Brooks Coordinator		TIME VISIT/ INSPECTION COMPLETED:	01:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On the above noted date and time, Licensing Program Analyst's (LPA's), Diana Brasel and Griselda Castellon conducted an announced Pre-Licensing inspection for a new preschool license. Upon arrival, LPA's signed in with the elementary school site staff. LPA's met with Facility Representative Katrina Brooks and proceeded to classroom 16. . Applicant is requesting to be licensed for (24) preschool children ages 2-5 in classroom 16. Hours of operation will be: Monday - Friday am session 8:00am - 11:00am and pm session 12:00pm - 3:00pm. All indoor and outdoor activity space utilized for the children was inspected today. LPA's informed Katrina Brooks that staff are required to maintain direct visual supervision of the children at all times during indoor and outdoor activities. When medications are on site, Katrina Brooks, stated that they will be stored at the school sites nurses office. A fully equipped first aid kit is located in the classroom. There is an operational carbon monoxide detector on site located in the classroom. All required licensing documents were observed posted in the classroom wall near entrance door. Children will be signed in and out at the classroom using Hubbe electronic sign in.

Belinda Devall
Diana Brasel
	DATE: 08/10/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2026

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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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 / CAMINO REAL ELEMENTARY	FACILITY NUMBER: 334847012
	VISIT DATE: 08/10/2026

NARRATIVE

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LPA continued to tour the facility and measured all indoor and outdoor activity space. Total indoor activity space measured 845.94, which is sufficient to accommodate the requested capacity. LPA's observed all indoor activity space to be complete with safe, age-appropriate furniture and equipment, including tables, chairs, cubbies, mats, bookshelves, and other activity supplies for the children. Drinking water is available in the classrooms via a filtered drinking water faucet. LPA observed all hazardous items to be inaccessible to children. There are no bodies of water or weapons on the property. Fire clearance was granted on 07/08/2026.

LPA observed a total of (2) sinks and (2) toilets available for children’s use. These are sufficient to accommodate the requested capacity of 24 children. There is a separate staff restroom equipped with a toilet and a sink. The isolation area for children who are ill will be the school sites nurses office.

Facility will provide breakfast to am session and lunch to pm session, meals will be brought in from Nutrition Services.

The facility currently has a fully fenced playground area. Fencing is chain link, and is at least four feet high. The total square footage for all the outdoor activity space is 12179.89, which is sufficient to accommodate the requested capacity. A playground waiver to share the elementary TK and Kinder playground at different times in the AM and PM has been submitted. Shade is provided via a large mesh canopy and trees. There are sufficient outdoor age-appropriate toys and play equipment available on the playground. There is a climbing structure on the playground which appears to be age appropriate and is properly anchored. There is adequate cushioning in fall zones of climber provided by rubber cushioning material.

NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Diana Brasel
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/10/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2026

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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: JUSD / CAMINO REAL ELEMENTARY	FACILITY NUMBER: 334847012
	VISIT DATE: 08/10/2026

NARRATIVE

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Drinking water is available via children's brought water bottles and water brought out in an igloo. LPA observed all hazardous items on the playground to be inaccessible to children. Facility representative Katrina Brooks was reminded that any changes to the facility must be reported to and approved by Community Care Licensing.

Facility representative was reminded that all adults 18 and over, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

Lead Testing- CCC Assembly Bill (AB) 2370, Chapter 676, Statutes of 2018, requires all licensed Child Care Centers (CCCs) constructed before January 1, 2010, to test their water (used for drinking and food preparation) for lead contamination before January 1, 2023, and then every 5-years after the date of the first test as specified in Health and Safety Code section 1597.16.

For child care center licenses issued after July 1, 2022, the licensee shall test their water for lead within 180 days of licensure pursuant to Written Directives section 101700 (PIN 21-21.1-CCP.).

LPA referred facility representative to the Department website for lead: Lead Toxicity Prevention and Water Testing Information (https://www.cdss.ca.gov/inforesources/child-care-licensing/water-testing-information) Include the applicable scenario for the CCC, un-bolded, into the report:

NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Diana Brasel
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/10/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2026

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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: JUSD / CAMINO REAL ELEMENTARY	FACILITY NUMBER: 334847012
	VISIT DATE: 08/10/2026

NARRATIVE

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This facility plans to provide Incidental Medical Services – IMS. For IMS information, see PIN 22-02-CCP. A Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice) or (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.

CCC LPA reviewed with facility representative the LIC 311A, Records to be Maintained at the Facility, for child’s records, personnel records, administrative records, and documents to be posted. Entrance Checklist was provided to the applicant.

Facility representative was informed of the MyChildCarePlan.org site, a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California. Subscribe to CCLD Important Information- Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters, and other important information communication platforms. To receive important licensed related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/communitycare-licensing/subscribe and select the Child Care option to receive email communication.

NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Diana Brasel
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/10/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2026

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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: JUSD / CAMINO REAL ELEMENTARY	FACILITY NUMBER: 334847012
	VISIT DATE: 08/10/2026

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	The following corrections are needed prior to the issuance of the license: 1. A granted shared playground waiver. Exit interview conducted and report was reviewed with the facility representative Katrina Brooks. Facility Representative Katrina Brooks understands that all proof of corrections must be provided to the Department within 30 days, or the application may be denied.

NAME OF LICENSING PROGRAM MANAGER: Belinda Devall
NAME OF LICENSING PROGRAM ANALYST: Diana Brasel
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/10/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2026

LIC809 (FAS) - (06/04)

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