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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372006255
Report Date: 10/17/2019
Date Signed: 10/17/2019 09:15:03 AM

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:MAAC PROJECT, FALLBROOK HEAD STARTFACILITY NUMBER:
372006255
ADMINISTRATOR:M'LINDA ROSOLFACILITY TYPE:
850
ADDRESS:405 W. FALLBROOK STREETTELEPHONE:
(760) 723-4189
CITY:FALLBROOKSTATE: CAZIP CODE:
92028
CAPACITY:60CENSUS: 35DATE:
10/17/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:05 AM
MET WITH:Vanessa WoodTIME COMPLETED:
09:25 AM
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A case management visit is being conducted by Licensing Program Analyst (LPA) James Wilkerson in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on 10/02/19. It indicates that a child got a hold of some children's scissors and tried to cut his/her clothing. A staff member asked the child for the scissors and and child reacted by biting the teacher (not breaking skin) and kicking the staff member. The facility is taking appropriate measures to implement further action to ensure this doesn't happen again in the future. Based on information gathered, the facility acted appropriately and no violations have been identified.


An exit interview was conducted and a copy of this report was provided to facility staff
SUPERVISOR'S NAME: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: James WilkersonTELEPHONE: (951) 218-7031
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2019
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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