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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600079
Report Date: 12/06/2024
Date Signed: 12/06/2024 03:50:44 PM

Document Has Been Signed on 12/06/2024 03:50 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 - JOHN MARSHALL HEAD STARTFACILITY NUMBER:
376600079
ADMINISTRATOR/
DIRECTOR:		SAMANTHA RIVEROFACILITY TYPE:
850
ADDRESS:3550 ALTADENA AVENUETELEPHONE:
(619) 624-2362
CITY:SAN DIEGOSTATE: CAZIP CODE:
92105
CAPACITY: 52TOTAL ENROLLED CHILDREN: 52CENSUS: 28DATE:
12/06/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:10 PM
MET WITH:Site Supervisor Samantha RiveroTIME VISIT/
INSPECTION COMPLETED:
03:55 PM
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On 12/06/24 at 2:10PM, Licensing Program Analyst (LPA) Luigi Gargaro conducted a case management visit with site supervisor Samantha Rivero regarding a self-reported 10/30/24 incident in which child #1 (C1) exited from his classroom and was found by another transitioning classroom teacher in the preschool playground.

During the course of the incident investigation, analyst conducted interviews with site supervisor Rivero and witnessing staff member #1 (S1) and reviewed report documentation. Analyst also inspected (C1)'s classroom and the preschool play yard that the child went to after exiting the classroom. Analyst was unable to interview the two classroom teachers primarily involved in the incident as they were not at the facility today. C1 is still attending the facility.

No violations were cited during today's visit. Today’s report was reviewed with and signed for by site supervisor, Samantha Rivero. A copy of the report, appeal rights and the notice of site visit, that is to be posted for 30 days, was provided to Ms. Rivero before analyst left the facility.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Luigi Gargaro
LICENSING EVALUATOR SIGNATURE: DATE: 12/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/06/2024
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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