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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370800215
Report Date: 12/07/2023
Date Signed: 12/07/2023 11:58:30 AM

Document Has Been Signed on 12/07/2023 11:58 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
MISSION VALLEY, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:FRANCIS W PARKER SCHOOLFACILITY NUMBER:
370800215
ADMINISTRATOR:ROBERTA BLICKFACILITY TYPE:
850
ADDRESS:4201 RANDOLPH STREETTELEPHONE:
(619) 298-9110
CITY:SAN DIEGOSTATE: CAZIP CODE:
92103
CAPACITY: 48TOTAL ENROLLED CHILDREN: 48CENSUS: 45DATE:
12/07/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH: Head of Lower-Class Heather Gray, and Director Robin Blick TIME COMPLETED:
12:20 PM
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On 12/07/2023 at 9:30 am, Licensing Program Analysts (LPAs) Michelle Hood and Shannan Williams, made an unannounced visit for the purpose to follow up on an incident that occurred on 09/12/2023. The facility representative failed to report the incident to the department within twenty-four hours after being notified by the child’s representative that a child was assessed by a physician on 09/18/2023. The facility representative failed to submit a LIC 624B - Unusual Incident Report to within seven days to the department.

The Head of Lower-Class Heather Gray, and the Director Robin Blick admitted the department was not notified within twenty-four hours and the LIC 624B was filed after seven days. After the LPA reviewed the LIC 624B, it was determined the report was dated 10/03/2023 by the Head of Lower School Heather Gray. The LPA, Head of Lower School, Assistant Head of Lower School and the Director discussed the reporting requirements, and the LPA provided the email (SDIncidentReports@dss.ca.gov) where future LIC 624B reports can be filed.

An exit interview was conducted, and the report was reviewed with the Director Robin Blick. The director was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. Notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. See the LIC 809D page for the deficiency cited.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Michelle Hood
LICENSING EVALUATOR SIGNATURE: DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/07/2023
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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Created By: Michelle Hood On 12/07/2023 at 11:26 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: FRANCIS W PARKER SCHOOL
FACILITY NUMBER: 370800215

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/05/2024
Section Cited
CCR
101212(d)(1)(B)

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101212(d)(1)(B) Reporting Requirements
Upon the occurrence, during the operation of the child care center of any of the events specified in... a report shall be made to the Department by telephone or fax... Dept. next working day...during its normal business hours. In addition, a written report containing the information specified in below shall be submitted to the Department within 7 days following the occurrence...
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The director stated she will report to the department within 24 hours and the LIC 624B to the department within 7 days. The director has reminded the staff to report incidents to her immediately even by text if needed.
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Any injury to any child that requires medical treatment. This requirement was not met by: The facility staff did not report the incident within 24 hours, and did not submit a LIC 624B to the department within 7 days. This is a potential rsk to children in care.
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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:Cynthia Gray
LICENSING EVALUATOR NAME:Michelle Hood
LICENSING EVALUATOR SIGNATURE:
DATE: 12/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/07/2023


LIC809 (FAS) - (06/04)
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