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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334844729
Report Date: 10/29/2019
Date Signed: 10/29/2019 03:38:35 PM

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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:BIG FUTURE PRESCHOOLFACILITY NUMBER:
334844729
ADMINISTRATOR:GRETTA WALDONFACILITY TYPE:
830
ADDRESS:40295 WINCHESTER RD.TELEPHONE:
(951) 296-1855
CITY:TEMECULASTATE: CAZIP CODE:
92591
CAPACITY:27CENSUS: 18DATE:
10/29/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:57 PM
MET WITH:Gretta WaldonTIME COMPLETED:
03:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Ana Noble arrived at the facility on a Case Management inspection to follow-up on an Unusual Incident Report (UIR) submitted to Community Care Licensing (CCL) by the facility on 10/16/19. The incident involves a Staff who fed an infant child the wrong breast milk.

The investigation conducted revealed that on October 15, 2019 at approximately 12:45 pm, during lunch coverage in the infant classroom, Child #1 was fed the incorrect breast milk by Staff #1. Staff #1 had stepped into the infant classroom to cover a lunch break for Staff #2, who is the regular infant teacher. Prior to Staff #2, leaving for their lunch, provided Staff #1 with instructions and updates on the children, regarding the children who would be waking up and would need to be fed. Upon Staff #2 returning from lunch, Staff #1 informed, Staff #2 that Child #1 had been fed the incorrect breast milk. Child #1 had consumed approximately an ounce of the breast milk.

Based on the information obtained during the course of this incident, the facility is in violation of Title 22 Regulations code: 101223(a)(2) Personal Rights To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.(SEE 809D).

Exit interview conducted with Ms. Gretta Waldon, Director and a copy of this report was left at the facility.

A copy of this report must be made available to the public for 3 years upon request.
SUPERVISOR'S NAME: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Ana NobleTELEPHONE: (951) 295-5832
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2019
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 STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: BIG FUTURE PRESCHOOL
FACILITY NUMBER: 334844729
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/29/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/29/2019
Section Cited

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Personal Rights. The licensee shall ensure that each child is accorded the following personal rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement was not met by evidence by: On 10/15/19, Child #1 was fed
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approximately an ounce of the wrong breast milk by Staff #1, which belong another child. This is an immediate risk to children in care.
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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: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Ana NobleTELEPHONE: (951) 295-5832
LICENSING EVALUATOR SIGNATURE:
DATE: 10/29/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/29/2019
LIC809 (FAS) - (06/04)
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