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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274415708
Report Date: 11/20/2019
Date Signed: 11/20/2019 01:04:19 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:LITTLE BEAR CREEK STATE PRESCHOOLFACILITY NUMBER:
274415708
ADMINISTRATOR:LORAINE DE LA TORREFACILITY TYPE:
850
ADDRESS:18250 VAN BUREN AVENUETELEPHONE:
(831) 443-7212
CITY:SALINASSTATE: CAZIP CODE:
93906
CAPACITY:120CENSUS: 98DATE:
11/20/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Mellisa AldermanTIME COMPLETED:
01:10 PM
NARRATIVE
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Licensing Program Analyst (LPA), Behbood, conducted an unannounced random visit to the Facility today. Former Site Supervisor Loraine De La Torre left on 10/05/19. Facility notified analysts visiting on 10/24/19. A new site director has been hired and will start on 12/01/19. Licensee will sent director's qualification packet to Nancy Rodriguez, CCL analyst for evaluation and approval. Melissa Alderman, Assistant Superintendent arrived during visit. LPA toured 5 classrooms and playground. Present also were 98 children and 16 staff. Teacher/child ratio met today.
LPA observed the required posted materials, including the Facility License, Emergency Disaster Plan (LIC 610), Earthquake Preparedness Checklist (LIC 9148), Parents' Rights Poster (PUB 393), Personal Rights (LIC 613A), Child Car Seat Law (PUB 269), Menus (includes current and following week), and Activity Schedule.
All staff have their criminal record clearances through School District. No bodies of water observed.
LPA reviewed samples of children's file and sign in and out sheets during today's visit. Each child's file reviewed contains the Information and Emergency Information form (LIC 700), their immunization records, and parent's consent for emergency medical treatment. LPA observed that all children were properly signed in and out (legal signature & time of day) by a parent or authorized representative. All staff have current CPR and First Aid certifications and proof of immunization on file. Staff files have copies of their educational background. Furniture & equipment appear in good condition. Floors appear clean. Children's bathrooms are in operating condition, however one install door is locked, a service request has been submitted.
Meals and snacks are delivered from district's kitchen daily,Preschool refrigerator appears clean & all food is covered. Trash can for food waste has a tight fitting cover. Menu is posted.
SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Mahvash BehboodTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2019
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: LITTLE BEAR CREEK STATE PRESCHOOL
FACILITY NUMBER: 274415708
VISIT DATE: 11/20/2019
NARRATIVE
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Playground has climbing structures, , sand boxes, etc. Wood chips are used for cushioning material.
Drinking water inside the classrooms via water pitcher and cups. The water fountain in the playground is not working and water wasn't available for children via other means.
Incidental Medical Services were discussed with the licensee. This facility provides Incidental Medical Services (IMS). LPA reviewed storage of medication and equipment /supplies, and reviewed children’s, personnel and administrative records.

Please see next page for citations under Title 22.

SUPERVISOR'S NAME: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Mahvash BehboodTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2019
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
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: LITTLE BEAR CREEK STATE PRESCHOOL
FACILITY NUMBER: 274415708
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/20/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/20/2019
Section Cited

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Drinking water from a non contaminating fixture or container shall be readily available both indoors and in the outdoor activity area. This requirement is not met as evidenced by broken water fountain in the playground and lack of water by other means. This poses a potential risk to the health and safety of the children in care.
Type B
12/06/2019
Section Cited

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Health and Safety - Mandated Child Abuse Reporter Training - All staff must complete the Mandated Child Abuse Reporter Training, This requirement is not met as evidenced by at least 2 of the staff that their files were reviewed didn't have certificate of completing this training from the CDSS.

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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: Anthony StudebakerTELEPHONE: (408) 324-2155
LICENSING EVALUATOR NAME: Mahvash BehboodTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:
DATE: 11/20/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/20/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3