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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600980
Report Date: 12/11/2024
Date Signed: 12/11/2024 11:37:54 AM

Document Has Been Signed on 12/11/2024 11:37 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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:MAAC PROJECT OCEANSIDE V HEAD STARTFACILITY NUMBER:
376600980
ADMINISTRATOR/
DIRECTOR:		FABRIGAS, JANEFACILITY TYPE:
850
ADDRESS:235 VIA PELICANOTELEPHONE:
(760) 433-7589
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY: 20TOTAL ENROLLED CHILDREN: 20CENSUS: 15DATE:
12/11/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:35 AM
MET WITH:Facility Representative Patricia Lemus TIME VISIT/
INSPECTION COMPLETED:
11:46 AM
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On the date and time listed above, Licensing Program Analyst (LPA) Kelly Gerth arrived at the facility for the purpose of conducting a case management visit. The Department received an unusual incident report (UIR) dated 11/05/2024, from the facility, stating a child had fallen and sustained injuries to the face, requiring medical attention on 10/23/2024.

LPA Gerth conducted interviews with pertaining parties, Staff 1- 3 (S1-S3) , and it was found that while in the outdoor activity space, Child 1 (C1) was running, tripping over own foot/leg and did not put hands out to cushion the impact of the fall in time resulting in a cut to the chin. S1 applied first aid measures while S3 contacted the family, the child was then taken to the doctor the same day resulting in 2 stitches. Per the facility representative, the child returned the following day and no further incidents have occurred.

LPA determined that the facility took the necessary steps to ensure children’s safety, including providing first aid to C1 and contacting the child’s parents immediately. Based on the information obtained during the visit, there appears to be no violations of Title 22 Regulations pertaining to the reported incident.



An exit interview was held with the Facility Representative. A Notice of Site visit was issued, along with a copy of this report.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Kelly Gerth
LICENSING EVALUATOR SIGNATURE: DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/11/2024
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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