370806105-8-22-2023-20-CC-CMER-CUXUWJ-20230822155646

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 370806105
Report Date: 08/22/2023
Date Signed: 08/22/2023 03:56:55 PM

Document Has Been Signed on 08/22/2023 03:56 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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME:	NHA NORTH PARK HEAD START FAMILY FOCUS CENTER		FACILITY NUMBER:	370806105
ADMINISTRATOR:	MINDY MULLIGAN		FACILITY TYPE:	850
ADDRESS:	2717 UNIVERSITY AVENUE		TELEPHONE:	(619) 298-4500
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92104
CAPACITY: 38	TOTAL ENROLLED CHILDREN: 38	CENSUS: 18	DATE:	08/22/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:21 AM
MET WITH:	Rachel Tibio		TIME COMPLETED:	01:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 8/22/2023 at 10:20 a.m. Licensing Program Analyst, Cindy Meier conducted an unannounced annual inspection and met with Director, Rachel Tibio. LPA disclosed the purpose of the inspection and toured the inside and outside of the facility. This is a full day program that operates year-round. Days and hours of operation are Monday – Friday, 7:30 a.m. - 5:00 p.m. There are three (3) classrooms in operation. The following ratios were observed: eighteen (18) children with eight (8) staff members. Furniture and equipment in the classrooms were observed to be in good condition, free of sharp, loose, or pointed parts. The surface of the outdoor activity space and playground equipment is maintained, is in safe condition and is free of hazards. The area under high climbing equipment and slides had rubber cushioning to absorb falls. There is sufficient cushioning to absorb falls under and around play equipment. The playground area includes shaded rest areas for children through the use of canopies and awnings. Toilet and hand washing equipment are in safe and sanitary operating condition. Floors in the facility are clean and safe. Solid waste storage containers have tight-fitting covers and are in good repair. Drinking water is available both indoors and outdoors. Napping equipment consists of cots which are kept in the classrooms and each cot has its own sheet or covering. Facility has a functioning carbon monoxide detector that meets statutory requirements. The last fire/disaster drill was conducted and documented on 8/17/23. The facility provides breakfast, lunch, and snacks. Menus are posted monthly. Food is prepared off site and delivered to facility daily. Notation of children’s allergies is accessible. All food is protected against contamination and any contaminated food is discarded immediately.

SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Cindy Meier
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023

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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Document Has Been Signed on 08/22/2023 03:56 PM - It Cannot Be Edited

Created By: Cindy Meier On 08/22/2023 at 12:25 PM

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: NHA NORTH PARK HEAD START FAMILY FOCUS CENTER	FACILITY NUMBER: 370806105
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/22/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101226(e)(3)(A)

Health-Related Services

(3) Prescription medications may be administered if all of the following conditions are met: (A) Prescription medications shall be administered in accordance with the label directions as prescribed by the child's physician. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review, the licensee did not comply with the section cited above in medication for Child 1 (C1) did not have label directors as prescribed by the child's physician which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/25/2023
	Plan of Correction
1 2 3 4	Director stated she will return the unlabeled medication to C1's parent.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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 Garay

LICENSING EVALUATOR NAME:

Cindy Meier

LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023

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 NORTH PARK HEAD START FAMILY FOCUS CENTER	FACILITY NUMBER: 370806105
	VISIT DATE: 08/22/2023

NARRATIVE

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Director stated there are no bodies of water or on the premises and LPA did not observe any bodies of water. Director stated there are no firearms, weapons, or ammunition allowed or stored on the premises. Disinfectants, cleaning solutions, medication and other hazardous items are made inaccessible to children. No poisons were observed during the inspection.

A review of staff records on this date indicates facility staff or other individuals who require caregiver background checks have received criminal record and child abuse clearances or exemptions. Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

All required notices, forms and license(s) were posted. Capacity and limitations as specified on the license are being maintained. At least one person trained in EMSA approved Pediatric CPR and First Aid is present when children are at the facility or at offsite activities. The name of the childcare center director or fully qualified teacher, designated to act in the director’s absence, has been reported to the Department. Children are under supervision, including visual supervision, of a teacher at all times. The person who signs the child in/out of the facility shall use their full signature and record the time of day. Sign in/out sheets reviewed and observed by the LPA meet this regulation. Facility maintains a ratio of one teacher supervising no more than eight children in care.

LPA reviewed a sample of children’s files and observed files were complete with contact information for authorized representative and or relatives or others who can assume responsibility for the child and medical assessment. LPA reviewed a sample of staff files and observed files were complete with health screening, immunization records for influenza, pertussis, and measles, and current documentation of completed mandated reporter training.

SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Cindy Meier
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023

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 NORTH PARK HEAD START FAMILY FOCUS CENTER	FACILITY NUMBER: 370806105
	VISIT DATE: 08/22/2023

NARRATIVE

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This facility provides Incidental Medical Services (IMS). LPA reviewed storage of medication, equipment/supplies, and reviewed children’s, personnel, and administrative records. LPA observed an inhaler and epic pen without a prescribed label in Classroom #3’s emergency backpack. Director removed the medication and will return to parents until appropriate labels are in place. Information regarding Americans with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301(voice), (800) 514-0383 (TDD) and website link ttps://www.ada.gov/childqanda.htm.
Director stated no children enrolled require medication at this time.

LPA and director discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, Mandated Reporter Training, Forms and Regulations, Safe Sleep in Childcare, Lead Poisoning Facts, Guardian and California Megan’s Law (www.meganslaw.ca.gov).

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, one Type B and one Technical Violation deficiencies were cited; see LIC809D. Technical Violation was cleared during inspection.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Exit interview conducted and report was reviewed with Director, Rachel Tibio. A copy of this report, along with Appeal Rights (LIC9058), were provided. A Notice of Site Visit was given and must remain posted for 30 days. LPA observed that the Notice of Site Visit was posted during the inspection. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Cindy Meier
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023

LIC809 (FAS) - (06/04)

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