372005150-7-19-2023-51-CC-GCUS-CTVPXY-20230719114307

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 372005150
Report Date: 07/19/2023
Date Signed: 07/19/2023 11:43:12 AM

Document Has Been Signed on 07/19/2023 11:43 AM - 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 SCHOOL		FACILITY NUMBER:	372005150
ADMINISTRATOR:	TAMARA HOLTHAUS		FACILITY TYPE:	850
ADDRESS:	1140 WEST MISSION ROAD		TELEPHONE:	(760) 744-1150
CITY:	SAN MARCOS	STATE: CA	ZIP CODE:	92069
CAPACITY:	108	CENSUS: 61	DATE:	07/19/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	08:20 AM
MET WITH:	Tamara Holthaus		TIME COMPLETED:	11:50 AM

NARRATIVE

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On July 19, 2023 at 8:20 a.m. Licensing Program Analyst, Leilani Curtis, conducted an unannounced inspection to follow up on two self-reported incidents that occurred on 6/29/23 and 7/7/23. Upon arrival LPA met with Site Supervisor Claribel Zorrilla and proceeded to tour the facility. There were 61 children with 17 staff members present. Appropriate ratio/capacity were observed. Staff members have the required background clearances and are associated to the facility. At approximately 8:30 a.m. Director Tamara Holthaus arrived at the facility.

LPA interviewed the director, staff #1 (S1), staff #2 (S2) and parent #1 (P1). On 06/29/23 at approximately 9:30 a.m., S1 and Staff #3 (S3) took their class on a walk to the baseball field. While the children were playing on the baseball field child #1 (C1) was stung by a bee. Staff members comforted the child and immediately contacted the child’s (C1) parent/guardian and campus police. Paramedics were called to the facility. The child was transported by the paramedics to the emergency room where he was treated for an allergic reaction to a bee sting. At the time of the incident there were 2 staff members and 16 children on the baseball field. Appropriate ratio was in effect at the time of the incident. C1 returned to the facility on 6/30/23. Facility staff responded appropriately, and the incident was reported to Community Care Licensing Timely. Facility staff did document the incident in the child’s file which is kept at the facility.

On 7/7/23 at approximately 9:40 a.m. child #2 (C2) was playing on the “ladder bars” when he fell and injured his left arm. At the time of the incident there were two staff members and seven children on the playground. Appropriate ratio was in effect at the time of the incident. S1 immediately applied ice to C2’s arm and comforted the child. The parent/guardian of C2 was called and the child was taken to the urgent care and diagnosed with a fractured left arm. C2 returned to the facility on his next scheduled day.

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace Curtis	TELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023

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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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: 07/19/2023

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LPA toured the playground and inspected the ladder bars. The bars are approximately 4 ft. 5 inches from the ground. The area underneath the bars is padded with rubber padding to absorb the impact from a fall. Facility staff responded appropriately, and the incident was reported to Community Care Licensing timely. Documentation regarding the incident is in the child’s file which is kept at the facility. The director states that after the incidents occurred Health and Safety issues, including how to respond to bees and other insects, and playground safety was discussed at the master teacher meeting held on 7/7/23.

See LIC809D for cited deficiency.

An exit interview was conducted, and this report was reviewed with Director Holthaus. Appeal Rights (LIC 9058) were provided. The director’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 the director post notice of site visit.

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace Curtis	TELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/19/2023 11:43 AM - 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: 07/19/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/31/2023 Section Cited CCR 101226.3(b)	1 2 3 4 5 6 7	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:	1 2 3 4 5 6 7	The director states that she will send LPA a letter detailing how she will ensure that staff are documenting injuries/illnesses in the children's files via email by 7/31/23.
	8 9 10 11 12 13 14	Based on interviews conducted by LPA and record review, on 6/29/23 a daycare child (C1) had an allergic reaction to a bee sting and was transported to the hospital emergency room. A record of this incident is not recorded in the child's record which is kept at the facility. This poses a potential health, safety, or personal rights risk to the children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	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: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace Curtis	TELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2023

LIC809 (FAS) - (06/04)

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