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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700650
Report Date: 10/31/2024
Date Signed: 10/31/2024 02:28:10 PM

Document Has Been Signed on 10/31/2024 02:28 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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:MAAC PROJECT - FALLBROOK HEAD START - INFANTFACILITY NUMBER:
376700650
ADMINISTRATOR/
DIRECTOR:		NATIVIDAD, JANETFACILITY TYPE:
830
ADDRESS:405 WEST FALLBROOK STREETTELEPHONE:
(760) 723-4189
CITY:FALLBROOKSTATE: CAZIP CODE:
92028
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 7DATE:
10/31/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:02 PM
MET WITH:Janet NatividadTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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On 10/31/24, Licensing Program Analyst (LPA), Kelli Waters, conducted an unannounced Case Management visit to follow up on Unusual Incident Report (UIR) that was submitted to Licensing by the facility on 10/07/24, regarding an incident that took place on 10/04/24. LPA met with Center Director, Janet Natividad to discuss incident.

The Director reported the following: on October 4, 2024, Staff #1 (S1) reported to the Director that Child #1 (C1) had been found with a hazardous item in their mouth while outside on the playground.

After investigating, LPA Waters determined that the facility took the necessary steps to ensure the safety of the children and provided additional staff training on Active Supervision and Safety. C1 was taken to the doctor and determined no harm was found. C1 returned to care the following school day.

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 conducted, and a copy of this report was provided.

A copy of this report must be made available to the public, at the facility site, for 3 years.
Carlos MartinezTELEPHONE: (951) 805-5739
Kelli WatersTELEPHONE: 951-782-4200
DATE: 10/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/31/2024
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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