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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700792
Report Date: 08/06/2019
Date Signed: 08/06/2019 08:40:45 AM

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 CHARTER PRESCHOOLFACILITY NUMBER:
376700792
ADMINISTRATOR:JESSICA VILLAFANAFACILITY TYPE:
850
ADDRESS:933 WEST SAN MARCOS BOULEVARDTELEPHONE:
(760) 744-3900
CITY:SAN MARCOSSTATE: CAZIP CODE:
92078
CAPACITY:49CENSUS: 15DATE:
08/06/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
06:55 AM
MET WITH:Jessica VillafanaTIME COMPLETED:
08:45 AM
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A case management visit is being conducted by Licensing Program Analyst (LPA) James Wilkerson in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on 07/25/19. It indicates that a child was using a restroom with a teacher and upon finishing they proceeded to go to the playground. The child was pushing open the door and tripped hitting his/her head/face on the door. The teacher was with the child and couldn't prevent the accident from happening as it happened too quickly.

Based on information gathered, the facility acted appropriately and no violations have been identified.

An exit interview was conducted and a copy of this report was provided to Ms. Villafana on this date.

A copy of this report must be made available upon request to the public for three years.
SUPERVISOR'S NAME: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: James WilkersonTELEPHONE: (951) 218-7031
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2019
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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