374845395-3-4-2020-51-CC-GCUS-BME37L-20200304170007

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374845395
Report Date: 03/04/2020
Date Signed: 03/04/2020 05:00:18 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 ECE LAB SCHOOL		FACILITY NUMBER:	374845395
ADMINISTRATOR:	HOLTHAUS, TAMARA		FACILITY TYPE:	830
ADDRESS:	1140 WEST MISSION ROAD		TELEPHONE:	(760) 744-1150
CITY:	SAN MARCOS	STATE: CA	ZIP CODE:	92069
CAPACITY:	12	CENSUS: 4	DATE:	03/04/2020
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Tamara Holthaus		TIME COMPLETED:	05:15 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	On March 4, 2020 at 2:00 p.m. Licensing Program Analyst (LPA) Leilani Curtis and Licensing Program Manager (LPM) Monica Cuddy visited the facility to conduct an annual random inspection. Upon arrival LPA and LPM met with Director Tamara Holthaus and proceeded to tour the facility. Also present were a total of 4 children in the following classrooms: Classroom #1: 4 children with staff Sari Morris and staff Jocelyne Hernandez. Appropriate ratios and capacity were observed. There are no bodies of water or weapons at this facility. Toys are safe and do not have sharp points, edges or splinters, or made of small parts that can be pulled off. There is sufficient infant napping equipment. Infant changing tables have padded surface no less than one inch thick, covered with washable vinyl, and raised sides at least 3 inches high. There are no walkers, bouncy seats, exersaucers or jumpers in the room. All infants including those napping in cribs are under visual observation at all times. Rooms have adequate heating, lighting, and ventilation. Solid waste storage vessels, including moveable bins, have tight-fitting covers on, and are in good repair. Disinfectants, hazardous items and medications are inaccessible to children through latches and locks or placed on high surfaces. The infant indoor and outdoor activity space is physically separate from the space used by other day care children. Outdoor play area is fenced with sufficient material for cushioning. The outdoor area has canopies used for shade. The infant room has a refrigerator used for infant food storage which is properly labeled by child name and date. Individual Needs and Services Plans were reviewed. Of the four children present today, three of them did not have a current or updated Needs and Services Plan. Drinking water is readily accessible inside and outside the classroom.

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace Curtis	TELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2020

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 ECE LAB SCHOOL	FACILITY NUMBER: 374845395
	VISIT DATE: 03/04/2020

NARRATIVE

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Personnel records were reviewed for qualifications. Staff utilized as infant teachers have three child development units in infant/toddler care. All personnel have required criminal record and child abuse index clearances. Admission Agreement forms reviewed for some children. There is an operational carbon monoxide detector at the facility. The alarm is not audible in the licensed facility. The alarm alerts the facilities department via computer who would then notify the director. Licensee is advised to obtain carbon monoxide detectors with alarms that are audible for the licensed space. Pediatric CPR/First Aid certifications are current. Staff members have completed the Mandated Child Abuse Reporting-per AB1207. LPA reviewed certifications and they are in compliance. Immunization records were also reviewed and are in compliance. Sign in/sign out sheets are well maintained. LPA provided a copy of the latest PINS, safe sleep regulation concept handout and SIDS handout to the Director to review. LPA obtained updated LIC 500, LIC 610 and Children’s Roster. The Director will update the LIC 309 and provide a copy to LPA by 3/18/20.

See LIC809D for cited deficiency. The Director was provided a copy of their appeal rights (LIC 9058 01/16) and her signature on this form acknowledges receipt of these rights. NOTICE OF SITE VISIT IS TO BE POSTED FOR 30 DAYS. LPA observed Director post notice of site visit.

Facility representatives were advised to regularly visit the Community Care Licensing WEB SITE: http://www.ccld.ca.gov/ for quarterly updates and updated regulation information. Duty Line was provided: (619) 767-2248.

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace Curtis	TELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2020

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 ECE LAB SCHOOL	FACILITY NUMBER: 374845395
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/04/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/18/2020 Section Cited	1 2 3 4 5 6 7	101419.3(a)(2) Modifications to Infant Needs and Services Plan: (a) The written infant needs and services plan shall be updated at least quarterly, or as often as necessary to assure its accuracy.(2) The authorized representative shall sign the plan to verify that he/she has participated in updating it. This requirement was not met as evidenced by:
	8 9 10 11 12 13 14	Based on LPA's facility record review staff members did not update the Infant Needs and Services Plan for three out of four infants. This poses a potential health and safety risk to children in care.	8 9 10 11 12 13 14
	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: 03/04/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2020

LIC809 (FAS) - (06/04)

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