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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376105055
Report Date: 11/05/2024
Date Signed: 11/05/2024 03:10:04 PM

Document Has Been Signed on 11/05/2024 03:10 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:CAMDEN HEAD STARTFACILITY NUMBER:
376105055
ADMINISTRATOR/
DIRECTOR:		DEBORAH DURHAMFACILITY TYPE:
850
ADDRESS:551 FARRAGUT CIRCLETELEPHONE:
(619) 499-5982
CITY:EL CAJONSTATE: CAZIP CODE:
92020
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: DATE:
11/05/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Deborah DurhamTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
NARRATIVE
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On 11/5/24 at 12:00pm, Licensing Program Analysts (LPAs) Patrick Ma and Renita Rodriguez, visited the facility to conduct a case management site inspection. The purpose of this visit is to follow up on a self-reported incident that occurred on 10/10/24. Upon arrival, LPA met with Director, Deborah Durham. During visit, LPA conducted children and staff interviews, made a confidential names list, and reviewed/received related documents.

Based on information gathered, Child C1 sustained an injury due to staff S1 lifting C1 by the arm. Facility management was notified and contacted parents. Facility immediately conducted an investigation and submitted an incident report to the Department. S1 was subsequently placed on administrative leave during investigation and employment was later terminated.

See LIC 809D for Type A deficiency cited.

LPAs Ma and Rodriguez informed facility representative Deborah Durham that this report dated 11/5/24 documents 1 Type A citation which shall be posted for 30 consecutive days as there was an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Ma and Rodriguez informed the facility representative to provide a copy of this licensing report dated 11/5/24 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with the facility representative Deborah Durham. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Patrick Ma
LICENSING EVALUATOR SIGNATURE: DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2024
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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Document Has Been Signed on 11/05/2024 03:10 PM - It Cannot Be Edited


Created By: Patrick Ma On 11/05/2024 at 02:32 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: CAMDEN HEAD START
FACILITY NUMBER: 376105055

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/06/2024
Section Cited
CCR
101223(a)(3)

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101223(a)(3): The licensee shall ensure that each child is accorded the following personal rights: To be free from corporal or unusual punishment, infliction of pain...or other actions of a punitive nature
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Director stated, after being informed of the injury an immediate investigation was conducted. S1 was placed on administrative leave during investigation and employment was subsequently terminated. Director stated staff's behavior was unaccepable. Deficiency cleared during visit.
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Based on information gathered, Child C1 sustained an injury due to staff S1 lifting C1 by the arm.
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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:Renesha Askew
LICENSING EVALUATOR NAME:Patrick Ma
LICENSING EVALUATOR SIGNATURE:
DATE: 11/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/05/2024


LIC809 (FAS) - (06/04)
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