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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600079
Report Date: 01/25/2023
Date Signed: 01/25/2023 11:08:21 AM


Document Has Been Signed on 01/25/2023 11:08 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:NHA - JOHN MARSHALL HEAD STARTFACILITY NUMBER:
376600079
ADMINISTRATOR:DOROTHEA SCHROEDERFACILITY TYPE:
850
ADDRESS:3550 ALTADENA AVENUETELEPHONE:
(619) 624-2362
CITY:SAN DIEGOSTATE: CAZIP CODE:
92105
CAPACITY:60CENSUS: 21DATE:
01/25/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:08 AM
MET WITH:Lead Teacher Beatrix SosaTIME COMPLETED:
10:45 AM
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On January 25th, 2023 at 10:08 AM, Licensing Program Analyst (LPA) Jo Ann Legaspi, conducted an unannounced case management inspection and met with Lead Teacher Beatrix Sosa. The purpose of this inspection was to ensure the facility's receipt of the Safe Sleep regulations. LPA disclosed the purpose of the inspection and was granted facility entry. There are currently four (4) classrooms in operation. The following ratios were observed:

Classroom #1 (serves children ages 3 years to 5 years):
There were five (5) children present with one (1) staff member.

Classroom #2 (serves children ages 3 years to 5 years):
There were six (6) children present with two (2) staff members.

Classroom #3 (serves children ages 18 months to 3 years):
There were five (5) children present with two (2) staff members.

Classroom #4 (serves children ages 18 months to 3 years):
There were five (5) children present with two (2) staff members.

The facility serves children aged 2 to 5 years. The facility has a toddler option for children aged 18 to 36 months. An infant is a child twenty-four (24) months and younger.

LPA provided Lead Teacher Beatrix Sosa with a blank LIC 9227 (Individual Sleeping Plan), example of a sleeping log and Provider Information Notice (PIN) 20-24-CCP. The following is a summary of the safe sleep requirements described in PIN 20-24-CCP.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: JoAnn R LegaspiTELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:
DATE: 01/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/25/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3


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
VISIT DATE: 01/25/2023
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· Cribs and cots must be free from all loose articles and objects, including blankets and pillows.

· Infants must not be forced to sleep, stay awake, or stay in the sleeping area.

· Infants must not be swaddled while in care.

· An infant’s head must not be covered while sleeping.

· If an infant falls asleep before being placed in a cot, for example, in a provider’s arms or stroller, the provider must move the infant to a crib or cot as soon as possible.

· Car seats will only be used for transportation and must not be used for sleeping within a childcare facility.

· All pacifiers cannot have anything attached, such as a stuffed animal or a clip meant to attach the pacifier to the infant’s clothing.

· Providers must check on sleeping infants every 15 minutes and document their condition to check for signs of distress, which includes, but is not limited to labored breathing, flushed skin color, increase in body temperature, and restlessness.

· The provider must have one crib or cot for each infant in care.



· The provider shall be able to visually observe the infant

· The provider shall be near enough to the sleeping infant to be able to hear them wake up.

The Child Care Licensing Program has a web page dedicated to Safe Sleep information, guidance, and resources. Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: JoAnn R LegaspiTELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
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
VISIT DATE: 01/25/2023
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A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with Lead Teacher Beatrix Sosa.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: JoAnn R LegaspiTELEPHONE: (619) 767-2239
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3