<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364842359
Report Date: 12/06/2023
Date Signed: 12/06/2023 01:54:35 PM

Document Has Been Signed on 12/06/2023 01:54 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:RIALTO U.S.D. KORDYAK ELEMENTARY SCHOOLFACILITY NUMBER:
364842359
ADMINISTRATOR:GOOD, KARENFACILITY TYPE:
850
ADDRESS:4580 MANGO AVENUETELEPHONE:
(909) 421-4201
CITY:FONTANASTATE: CAZIP CODE:
92336
CAPACITY: 44TOTAL ENROLLED CHILDREN: 44CENSUS: 32DATE:
12/06/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Emily Sigala, Instructional Assistant TIME COMPLETED:
02:05 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 this date and time, Licensing Program Analysts (LPAs) Taityana Benson and 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 11/29/2023. LPAs met with Emily Sigala, Instructional Assistant to discuss the purpose of the visit. LPAs observed 19 children in preschool classroom 1 and 13 children in preschool classroom 2.

UIR stated on 11/28/2023 staff begin to transition children from outdoor time to classroom B102. At 2:00pm the children lined up and staff conducted a head count. When staff conducted their head count, there were 11 children present. One staff discovered a child was not in line during the head count. That staff notified the remaining three staff and all four staff began searching for the unaccounted child on the playground. When searching for the child it was discovered that a Kindergarten teacher left the gate open and the unaccounted child made their way onto the school bus. The bus driver notified the Assistant Principal about the extra child on the bus. At that time staff made their way outside the gate and found the child with the Assistant Principal and returned the child to 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: Taityana Benson
LICENSING EVALUATOR SIGNATURE: DATE: 12/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/06/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
Document Has Been Signed on 12/06/2023 01:54 PM - It Cannot Be Edited


Created By: Taityana Benson On 12/06/2023 at 12:42 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: RIALTO U.S.D. KORDYAK ELEMENTARY SCHOOL
FACILITY NUMBER: 364842359

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/07/2023
Section Cited
CCR
101229(a)(1)

1
2
3
4
5
6
7
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:
1
2
3
4
5
6
7
Facility staff understands the importance of this regulation and the importance of providing adequate care and supervision of children in care at all times. Facility agrees to submit a detailed plan on how supervision will be maintained during transition periods to prevent further incidents to CCL by 12/07/23.
8
9
10
11
12
13
14
Based on observation and records reviewed, facility staff failed to provide proper care and supervision for a child that was unaccounted for while transitioning from outdoor time to the classroom. This poses an immediate health, safety and personal rights risk to children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Taityana Benson
LICENSING EVALUATOR SIGNATURE:
DATE: 12/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/06/2023


LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: RIALTO U.S.D. KORDYAK ELEMENTARY SCHOOL
FACILITY NUMBER: 364842359
VISIT DATE: 12/06/2023
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
Exit interview conducted and report was reviewed with the Emily Sigala, Instructional Assistant.

LPA Taityana Benson informed authorized representative that this report dated 12/06/23 document(s) 1 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

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.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.



LPA Taityana Benson informed authorized representative to provide a copy of this licensing report dated 12/06/23 that documents any Type A citation(s) 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.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Taityana Benson
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3