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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364807712
Report Date: 05/24/2023
Date Signed: 05/24/2023 10:33:56 AM

Document Has Been Signed on 05/24/2023 10:33 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:RIALTO U.S.D. TRAPP ELEMENTARY SCHOOLFACILITY NUMBER:
364807712
ADMINISTRATOR:GOOD, KARENFACILITY TYPE:
850
ADDRESS:2750 N. RIVERSIDE AVE.TELEPHONE:
(909) 820-7912
CITY:RIALTOSTATE: CAZIP CODE:
92377
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 18DATE:
05/24/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Lead Teacher William VillalpandoTIME COMPLETED:
10:45 AM
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On this date and time, Licensing Program Analyst (LPA) Laura Mejorado conducted an unannounced visit to the facility for the purpose of following up on the submission of an Unusual Incident Report (UIR) that was received by the Regional Office on 05/10/2023. LPA met with lead teacher William Villalpando to discuss the purpose of the visit.

UIR stated on 05/10/2023 staff transitioned children to the school's cafeteria for lunch as they were practicing getting ready for kindergarten. At 9:50am the children lined up and staff conducted a head count. The three staff in the classroom escorted the children to the cafeteria where they had their lunch. When the staff and children returned to the classroom, they discovered a child had been left behind. The child was crying and stated “you guys forgot me”, staff immediately comforted the child. Staff believes the child had to use the bathroom before they left and when the child exited the bathroom everyone was gone. According to the UIR the incident occurred around 10:00am – 10:45am, where the child was left alone and unsupervised in the classroom. UIR stated the Child's Parent/Guardian was immediately contacted about this incident. Along with the submitted UIR, Facility Administration included written statements from staff involved as well as a plan of action to correct and prevent this type of incident from occurring again in the future.

The facility was found to be in violation of the following Title 22 regulation:

101229(a)(1) Responsibility for Providing Care and Supervision
(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.

See LIC809D for cited Type A deficiency

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Laura Mejorado
LICENSING EVALUATOR SIGNATURE: DATE: 05/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/24/2023
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: RIALTO U.S.D. TRAPP ELEMENTARY SCHOOL
FACILITY NUMBER: 364807712
VISIT DATE: 05/24/2023
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Upon receipt of this report, the Licensee shall post the Notice of Site Visit and any Licensing report documenting a type “A” deficiency. The report and the Notice of Site Visit shall be posted for 30 consecutive days. Failure to maintain posting as required, will result in an immediate $100 civil penalty. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). The Acknowledgement of Receipt (LIC 9224 form must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC 9224).


A copy of this report and Appeal Rights (LIC9058) were provided during this inspection.

Exit interview conducted and report was reviewed with lead teacher William Villalpando.

A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Laura Mejorado
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 05/24/2023 10:33 AM - It Cannot Be Edited


Created By: Laura Mejorado On 05/24/2023 at 09:46 AM
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: RIALTO U.S.D. TRAPP ELEMENTARY SCHOOL
FACILITY NUMBER: 364807712

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/24/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/25/2023
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision: (a) The licensee shall provide care and supervision 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. This requirement is not met as evidenced by:
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Facility staff understands the importance of this regulation and the importance of providing adequate care and supervision of children in care at all times. An action plan was submitted to CCL which includes staff conducting head counts when entering and exiting the class, physically checking the bathrooms, reviewing class roster/sign in sheet making sure all children are accounted.
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Based on observation and records reviewed, facility staff failed to provide proper care and supervision for a child that was left behind in their classroom while transitioning others to the school's cafeteria. This poses an immediate health, safety and personal rights risk to children in care.
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Facility staff agree to create a daily log which will assist them in accounting for all children in care which shall be made available for review by CCL. Facility agrees to submit a sample log to CCL by 5/26/23. Due to the seriousness of the incident and the facilities non-compliance history an office meeting will be scheduled to further discuss the facilities compliance history.

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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:Kimberly Williams
LICENSING EVALUATOR NAME:Laura Mejorado
LICENSING EVALUATOR SIGNATURE:
DATE: 05/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2023


LIC809 (FAS) - (06/04)
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