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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700979
Report Date: 03/22/2023
Date Signed: 03/22/2023 02:44:17 PM

Document Has Been Signed on 03/22/2023 02:44 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:BIG TREE, LITTLE PRESCHOOL, INC.FACILITY NUMBER:
376700979
ADMINISTRATOR:PATRICIA SILVAFACILITY TYPE:
850
ADDRESS:1600 BUENA VISTA DRIVETELEPHONE:
(760) 685-5780
CITY:VISTASTATE: CAZIP CODE:
92081
CAPACITY: 27TOTAL ENROLLED CHILDREN: 27CENSUS: DATE:
03/22/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:33 PM
MET WITH:Licensee Rebecca CookTIME COMPLETED:
02:03 PM
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On March 22, 2023 at 1:33 pm, Licensing Program Analysts (LPA) Jessica Rubio and William Chancellor arrived unannounced to the facility to conduct a case management visit due to an unusual incident report received for an incident that occurred on 3/6/2023, involving child (C1) falling from a play structure on the playground and later requiring medical attention. LPAs met with Licensee Rebecca Cook and Director Elizabeth Bannon and conducted a tour of the facility. During the visit, LPAs conducted interviews with C1, licensee, and two staff (S1, S2) who were present on the playground when the incident occurred. Interviews and record review revealed the staff were in ratio at the time of the incident and S1 observed C1 fall. Staff did notify C1's parents of the incident. LPAs 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 Licensee Rebecca Cook. A notice of site visit was also provided and must remain posted for 30 days.

SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Jessica M Rubio
LICENSING EVALUATOR SIGNATURE: DATE: 03/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/22/2023
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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