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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845457
Report Date: 03/23/2023
Date Signed: 03/23/2023 03:52:35 PM


Document Has Been Signed on 03/23/2023 03:52 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
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501



FACILITY NAME:GROWING TREE MONTESSORI PRESCHOOLFACILITY NUMBER:
334845457
ADMINISTRATOR:DENG, QIFACILITY TYPE:
840
ADDRESS:31935 VIA RIO TEMECULA ROADTELEPHONE:
(951) 900-8999
CITY:TEMECULASTATE: CAZIP CODE:
92592
CAPACITY:44CENSUS: 17DATE:
03/23/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:48 PM
MET WITH:Julia FletesTIME COMPLETED:
03:15 PM
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On March 23, 2023 at 1:40 pm, Licensing Program Analyst (LPA) Wiliam Chancellor and Jessica Rubio arrived unannounced to the facility to conduct a case management visit, due to an unusual incident report received for an incident that occurred on 03/03/2023, involving child (C1). C1 was playing on the school age playground and bumped their eyebrow on the play structure and required medical attention.

LPA's met with Director (AD) Julia Fletes and conducted a tour of the facility . During the visit, LPA's conducted interviews with C1 and two staff (S1, S2) who were present on the playground when the incident occurred. Interviews revealed the staff were in ratio at the time of the incident, S2 observed the incident. Staff provided appropriate first-aid and notified the parents of C1 after the incident.

LPA determined that the facility was not in violation of Title 22 Regulations.

An exit interview was conducted, a copy of this report, LIC 811 (Confidential Names List) and appeal rights were reviewed with and provided to Director Julia Fletes. A notice of site visit was also provided and must remain posted for 30 days.

SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: William M Chancellor Jr.TELEPHONE: 951-970-1388
LICENSING EVALUATOR SIGNATURE:
DATE: 03/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/23/2023
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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