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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370806487
Report Date: 07/09/2025
Date Signed: 07/09/2025 03:14:49 PM

Document Has Been Signed on 07/09/2025 03:14 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:NHA HOME AVENUE HEAD START FAMILY FOCUS CENTERFACILITY NUMBER:
370806487
ADMINISTRATOR/
DIRECTOR:		MARTHA SHIELDSFACILITY TYPE:
850
ADDRESS:4111 HOME AVENUETELEPHONE:
(619) 262-8199
CITY:SAN DIEGOSTATE: CAZIP CODE:
92105
CAPACITY: 120TOTAL ENROLLED CHILDREN: 120CENSUS: 16DATE:
07/09/2025
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:Martha Shields, Site SupervisorTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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On 07/09/25 at 9:50AM, Licensing Program Analyst (LPA) Luigi Gargaro conducted an unannounced annual inspection. The facility is a full day program which operates Monday-Friday from 7:00AM-4:3d0PM. Upon arrival, LPA met with Site Supervisor Martha Shields and proceeded to tour the facility. The Head Start Preschool classrooms (rooms #2, #3, #4, #5 and #6) were on summer break with only the two toddler Early Head Start classrooms (rooms #1A and #1B) operating today.

The following ratios were observed: Toddler Classroom #1A had 8 children under the supervision of lead teacher Lorena Resendiz and TAT Elizabeth DeBerry; Toddler Classroom #1B had 7 children under the supervision of lead teacher Alicia Alonzo and associate teacher Najla Shelby. Facility was within staffing ratio during LPA's tour. All staff members have the required background clearances and are associated to the facility

All required notices, forms and license(s) were posted. Furniture and age appropriate equipment is in good condition. Rooms have adequate heating, lighting, ventilation and drinking water. Storage cubbies are readily available, and rooms accommodates class size. Napping equipment consists of cots which are kept in the classrooms and each cot has its own sheet or covering. Bathrooms are maintained with operational toilets and faucets with appropriate temperature.

Paper towels and toilet paper are available. Bathroom is lighted and has ventilation. Facility provides breakfast, lunch and snacks to children that is prepared at the NHA central kitchen and warmed or refrigerated as required in the facility's kitchen before being served to children. A meal menu is posted. Adequate food is available for meals and snacks.

Jason Garay
Luigi Gargaro
DATE: 07/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: NHA HOME AVENUE HEAD START FAMILY FOCUS CENTER
FACILITY NUMBER: 370806487
VISIT DATE: 07/09/2025
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Outdoor play area is a fenced cement and turfed yard with a separate one for the preschool classes and for the toddler classes. Both yards have a shade structure for children. Equipment is age appropriate for preschool and toddler children, respectively. Children have drinking water provided from water dispensers and an outdoor container that is dispensed into individual plastic cups. Grounds are free of debris or potential hazards. LPA reviewed sign in sheets and medication policy and storage. Isolation area is the Director's office. Personnel and client records were reviewed and all staff members have completed the online mandated child abuse training and personnel have required criminal record and child abuse index clearances or exemptions.

LPA reviewed Emergency Disaster Plan and last fire and earthquake drills were conducted on 06/20/25. Facility has an operating carbon monoxide detector located in the classrooms. Facility has at least one staff member that has a valid EMSA approved CPR/FA certificate when children are in care.

This facility provides Incidental Medical Services – IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. When any IMS is provided, an updated Plan of Operation that includes IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm. Analyst was able to review the medication and documentation for each respective child who is administered medication and found it to be in order.

Licensee representative was reminded that corporal punishment, smoking, exersaucers, bouncy seats, walkers, and jumpers are not allowed in day care.

Child Care Providers can now sign up for Quarterly Updates and PINS through the DSS website at https://cdss.ca.gov/inforesources/community-care-licensing/subscribe. LPA discussed California Megan's Law with provider and advised her to go on the website at www.meganslaw.ca.gov.

To improve the quality and value of the inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

SUPERVISOR'S NAME: Jason Garay
LICENSING EVALUATOR NAME: Luigi Gargaro
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME: NHA HOME AVENUE HEAD START FAMILY FOCUS CENTER
FACILITY NUMBER: 370806487
VISIT DATE: 07/09/2025
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Facility representative was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with facility representative and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed facility representative of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

All unusual incident reports shall be submitted to Licensing office via email at SDIncidentReports@dss.ca.gov or via fax at (619)767-2203.

No violations were cited during today's visit.

An exit interview was conducted with the facility site supervisor, Martha Shields. The supervisor was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights.



A notice of site visit was provided and is to be posted at the facility for 30 days. Failure to keep notice posted will result in a civil penalty of $100.00.
SUPERVISOR'S NAME: Jason Garay
LICENSING EVALUATOR NAME: Luigi Gargaro
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2025
LIC809 (FAS) - (06/04)
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