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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274415708
Report Date: 02/11/2022
Date Signed: 02/15/2022 03:04:01 PM


Document Has Been Signed on 02/15/2022 03:04 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
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: 57DATE:
02/11/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Elia Garcia TIME COMPLETED:
12:25 PM
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Licensing Program Analyst (LPA) Elizabeth Larios conducted a case management inspection in response to an incident that was self reported by facility to the Department on December 17, 2021 involving preschool children. LPA met with Site Coordinator, Elia Garcia, and explained the purpose of the inspection. LPA interviewed the Site Coordinator, and Preschool Substitute. LPA toured the restrooms.

Exit interview was conducted and report was reviewed with Site Coordinator. No deficiencies were cited.

A NOTICE OF SITE VISIT WAS GIVEN AND MUST REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Joel SeguraTELEPHONE: (408) 334-8550
LICENSING EVALUATOR NAME: Elizabeth LariosTELEPHONE: (408) 497-9236
LICENSING EVALUATOR SIGNATURE:
DATE: 02/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/11/2022
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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