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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600079
Report Date: 05/29/2019
Date Signed: 05/29/2019 11:26:50 AM

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:NHA - JOHN MARSHALL HEAD STARTFACILITY NUMBER:
376600079
ADMINISTRATOR:SCHROEDER, DOROTHEAFACILITY TYPE:
850
ADDRESS:3550 ALTADENA AVENUETELEPHONE:
(619) 624-2362
CITY:SAN DIEGOSTATE: CAZIP CODE:
92105
CAPACITY:60CENSUS: 46DATE:
05/29/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Site Supervisor Dorothea SchroederTIME COMPLETED:
11:30 AM
NARRATIVE
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LPA, Luigi Gargaro, conducted an unannounced case management visit today to follow up on a personal rights violation incident that was self reported by the facility. The incident occurred when child #1 did not want to voluntarily nap during facility nap time and staff #1 interceded in an attempt to make the child adhere to the scheduled activity.

During the course of reviewing the incident, analyst interviewed the facility director, the staff member involved in the incident, a second witness staff member and reviewed the facility recording of what occurred. Based on the evidence gathered, analyst found that the staff member in question did, in fact, violate the child's personal rights when she inappropriately physically directed the child to her cot and then subsequently attempted to restrain her when she attempted to get up from it until she was finally accompanied to another area and activity by the director.

Facility was cited a Type A deficiency for the personal rights violation (see related 809D deficiency page). Upon receipt of a type A violation, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. Analyst printed a copy of the Notice Of Site Visit today and had the director place it in her public postings area before he left the facility.
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi GargaroTELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2019
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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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: NHA - JOHN MARSHALL HEAD START
FACILITY NUMBER: 376600079
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/29/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/29/2019
Section Cited
CCR
101223(a)(1)
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Personal Rights. The licensee shall ensure that each child is accorded the following personal rights: To be accorded dignity in his/her personal relationships with staff and other persons. This requirement was not met when staff #1 physically directed a child who did not want to nap to her cot and then attempted to
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The facility corrected the violation with a "Code Of Ethical Behavior" all staff training on 11/21/18, that included review of children's personal rights, and submitted copies of staff sign in sheet to analyst. Staff member involved in interaction was terminated by facility after review of incident.
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restrain her when she tried get up from it during an 11/09/18 incident. Attempting to restrain a child who is not ready for a napping or other day care activity is a violation of their personal rights and an immediate risk to their physical and emotional health and safety.
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Analyst will review final incident finding with manager and advise whether facility will need to meet any other requirements.
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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: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Luigi GargaroTELEPHONE: (619) 767-2229
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2019
LIC809 (FAS) - (06/04)
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