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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372005150
Report Date: 03/22/2023
Date Signed: 03/22/2023 03:55:13 PM


Document Has Been Signed on 03/22/2023 03:55 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:PALOMAR COMMUNITY COLLEGE DISTRICT ECE LAB SCHOOLFACILITY NUMBER:
372005150
ADMINISTRATOR:TAMARA HOLTHAUSFACILITY TYPE:
850
ADDRESS:1140 WEST MISSION ROADTELEPHONE:
(760) 744-1150
CITY:SAN MARCOSSTATE: CAZIP CODE:
92069
CAPACITY:108CENSUS: 77DATE:
03/22/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Tamara HolthausTIME COMPLETED:
04:05 PM
NARRATIVE
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On March 23, 2023 at 3:00 p.m. Licensing Program Analyst, Leilani Curtis, conducted an unannounced case management inspection. LPA met with Site Supervisor Claribel Zorilla and proceeded to tour the facility. There were 77 children with 15 staff members present. Appropriate ratio/capacity were observed. Staff members have the required background clearances and are associated to the facility.

On 1/18/23 a daycare child (C1) became ill and was vomiting in a classroom. After remaining in the classroom for approximately 45 minutes the parent/guardian of C1 was notified and the child was removed from the facility. Facility staff failed to record the illness/incident in the child’s record which is maintained at the facility. Site Supervisor Zorrilla states that typically an email is sent to parents to notify them of their child's illness but in this case it was not done. Ms. Zorrilla also states that the facility has re-implemented an illness report to be given to the parent of an ill child at the time of pick up.

See LIC809D for cited deficiency.

An exit interview was conducted, and this report was reviewed with Ms. Zorrilla. Appeal Rights (LIC 9058) were provided. Ms. Zorrilla's signature on this form acknowledges receipt of these rights. LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS. LPA observed Ms. Zorrilla post notice of site visit.

SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace CurtisTELEPHONE: (619) 767-2235
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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Document Has Been Signed on 03/22/2023 03:55 PM - It Cannot Be Edited

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: 03/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/28/2023
Section Cited

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101226.3 Observation of the Child: (b) Any unusual behavior, any injury or signs of illness requiring assessment and/or administration of first aid by staff shall be reported to the child's authorized representative and recorded in the child's record. This requirement was not met as evidenced by:
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Site Supervisor Zorrilla states that she will conduct a staff meeting regarding observation of the child and illness & injury documentation. Ms. Zorrilla will send LPA a copy of the meeting agenda and staff sign in sheet via email by 4/28/23.
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Based on interviews conducted by LPA and record review, on 1/18/23 a daycare child (C1) was ill and vomiting in a classroom. A record of this incident is not recorded in the child's record which is kept at the facility. This poses a potential health and safety risk to the children in care.
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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: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace CurtisTELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2023
LIC809 (FAS) - (06/04)
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