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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374845136
Report Date: 12/01/2022
Date Signed: 12/01/2022 02:12:18 PM


Document Has Been Signed on 12/01/2022 02:12 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:MAAC LINDA VISTA HEAD STARTFACILITY NUMBER:
374845136
ADMINISTRATOR:JANE FABRIGASFACILITY TYPE:
850
ADDRESS:1587 LINDA VISTA DRIVETELEPHONE:
(760) 744-7995
CITY:SAN MARCOSSTATE: CAZIP CODE:
92069
CAPACITY:30CENSUS: 5DATE:
12/01/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Nancy AwadallaTIME COMPLETED:
02:20 PM
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On December 1, 2022 at 12:20 p.m. Licensing Program Analyst, Leilani Curtis, conducted an unannounced inspection to follow up on a self-reported incident that occurred on 11/04/22, wherein a 2-year-old child (C1) was injured when another child (C2) fell on top of C1 on the playground. LPA met with Director Nancy Awadalla and proceeded to tour the facility. There were 5 children with 2 staff members present. Appropriate ratio/capacity was observed. Staff members have the required background clearances and are associated to the facility.

LPA interviewed staff #1 (S1), staff #2 (S2), and the director. On 11/4/22 there were 7 children with 2 staff members on the playground. Proper ratio/supervision was in place. At approximately 10:50 a.m. C2 was running on the playground when she accidentally bumped into and fell onto C1. C1 immediately indicated that her left arm hurt. Staff comforted C1 and applied ice to her arm. The parent of C1 was notified of the incident the same day. C1 was taken to urgent care and diagnosed with an elbow fracture. C2 was not injured. The director states that after the incident she conducted a staff meeting on active supervision, staff placement on the playground, and staff responsibilities when incidents/accidents happen. LPA observed the playground to be safe and free of hazards. Staff acted appropriately and reported the incident timely.

No deficiencies are cited.

An exit interview was conducted with the director and appeal rights (LIC 9058) were discussed. 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 DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace CurtisTELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:
DATE: 12/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/01/2022
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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