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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274415708
Report Date: 01/29/2020
Date Signed: 01/29/2020 09:53:05 AM

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: 90DATE:
01/29/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:10 AM
MET WITH:Elia GarciaTIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA), Joe Macias, conducted an unannounced Case Management Inspection in response to an unusual incident that the facility self reported to Community Care Licensing (CCL). LPA met with the Site Supervisor Elia Garcia, and explained the nature of today's visit to her.

This visit was made to inquire about an unusual incident that occurred on January 21, 2020.

During today's visit LPA Macias toured the facility, interviewed staff, reviewed facility files, and obtained copies of pertinent information. Based on staff interviews, as well as the self reported incident report; a child bit another child during a time of transition. The incident was observed by the classroom teacher. First Aide was immediately applied, and parents were notified.

LPA reviewed the requirements for documenting an unusual incident with the Site Supervisor. LPA explained that all information should be filled in if applicable.

No deficiencies cited, exit interview conducted, and a copy of this report was provided to the facility.

A NOTICE OF SITE VISIT WAS ISSUED, POSTED NEAR THE FRONT ENTRANCE TO THE CENTER, AND MUST REMAIN POSTED FOR 30 CONSECUTIVE DAYS.

SUPERVISOR'S NAME: Sandy KnightTELEPHONE: (408) 324-2151
LICENSING EVALUATOR NAME: Joseph MaciasTELEPHONE: (408) 334-8320
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2020
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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