372005150-10-15-2019-51-CC-JREG-BGYQL6-20191015121525

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 372005150
Report Date: 10/15/2019
Date Signed: 10/15/2019 12:15:34 PM

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:	PALOMAR COMMUNITY COLLEGE DISTRICT ECE LAB SCHOOL		FACILITY NUMBER:	372005150
ADMINISTRATOR:	TAMARA HOLTHAUS		FACILITY TYPE:	850
ADDRESS:	1140 W. MISSION ROAD		TELEPHONE:	(760) 744-1150
CITY:	SAN MARCOS	STATE: CA	ZIP CODE:	92069
CAPACITY:	108	CENSUS: 85	DATE:	10/15/2019
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Director Tamara Hothaus		TIME COMPLETED:	12:25 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst, Joelle Redding, made an unannounced visit to follow up on a self reported incident that occurred on 9/26/19 wherein a 2 year old child (Child #1) was left behind on the playground during a transition to the classroom. LPA interviewed Staff #1, 2, 3 & 4. Staff #1 stated that it was parent open house day and there were several new children present. Staff #1 had her children out on the playground. At 4:30, Room 3 joined them and Staff #2 stayed with the group. They have a white board that they write down all the names of the children to use during transitions. At approximately 4:50, they started the transition back into Staff #1's classroom. There were 10 names on the white board to include her classroom, Room #3's remaining children, and two new children who were on the list because their parents were attending Open House. There was a head count done on the way in by both Staff #1 and Staff #2, one when they got into the classroom, one as they left the classroom to go to the Gross Motor room, another done entering the Gross Motor room and a final as they were all inside. The head count remained at 10 as reflected on the white board. Staff #1 states that shortly after the transition into the Gross Motor room, Child #1's parent arrived to pick him up. At that time Staff #2 stated that Child #1's name was not on the board. She had erased it when she heard him saying "mommy" outside, thinking that he had been picked up, thus the reason the head count and the names on the white board continued to match, without Child #1. Staff #1 immediately went out to the playground to look for him. In the meantime, Staff #3 noticed Child #1 outside in the sandbox when she was talking with a parent. She informed her co-teacher, Staff #4 who went to retrieve Child #1 who was happily playing and not in distress. Staff #3 stated that she kept her eyes on Child #1 until Staff #4 reached him. Staff #1 stated that she took him to Room 3 and was picking up the phone to call to the Gross Motor Room when she saw Staff #1 run by calling Child #1's name. She opened the door to call to her and she saw Child #1's mother who told her to let Staff #1 know that he was found. Staff #4 transferred Child #1 to his mother and informed Staff #1 that he was found. Staff #4 stated that she knows she made the call at 5:10 p.m. because she noted the time and that it took her approximately 5 minutes to bring him from the playground to Room 3.

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Joelle Redding	TELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2019

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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: PALOMAR COMMUNITY COLLEGE DISTRICT ECE LAB SCHOOL	FACILITY NUMBER: 372005150
	VISIT DATE: 10/15/2019

NARRATIVE

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Based on this information, Child #1 was without the direct supervision of a teacher for approximately 5 to 7 minutes. Child #1 was in a contained and hazard free environment. He had suffered no harm and was not in any distress when retrieved. The facility was in ratio and supervision and transition procedures were in place. Because of these circumstances, this situation is considered a potential rather than immediate risk to the health and safety of children in care and a Type B deficiency will be cited on the accompanying LIC 809 D.

Appeal Rights (1/16) were discussed and provided. Signature at the bottom of this report confirms receipt.

NOTICE OF SITE VISIT WAS POSTED AND WILL REMAIN POSTED FOR 30 DAYS.

SUPERVISOR'S NAME: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Joelle Redding	TELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2019

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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108

FACILITY NAME: PALOMAR COMMUNITY COLLEGE DISTRICT ECE LAB SCHOOL	FACILITY NUMBER: 372005150
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/15/2019

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/29/2019 Section Cited	1 2 3 4 5 6 7	Care and Supervision. No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time...This requirement was not met as evidenced by the fact that Child #1 was without the direct supervision of a teacher for approximately 5 to 7 minutes when the rest of the children transititioned indoors.
	8 9 10 11 12 13 14	This determination was based upon LPAs interviews with Staff #1 thru 4. This is a potential rather than immediate risk to the health and safety of children in care due to the fact that the child was in a hazard free, contained environment, was not in distress or harmed.	8 9 10 11 12 13 14	roster will be submitted to Licensing as verification of correction by 10/29/19.
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

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: Monica Cuddy	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Joelle Redding	TELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2019

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2019

LIC809 (FAS) - (06/04)

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