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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600079
Report Date: 12/17/2024
Date Signed: 12/19/2024 05:03:29 PM

Document Has Been Signed on 12/19/2024 05:03 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: DATE:
12/17/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Site Supervisor Samantha RiveroTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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On 12/17/24 at 1:00PM, Licensing Program Analyst (LPA) Luigi Gargaro conducted a follow up case management visit regarding a self-reported 11/05/24 lack of supervision incident in which child #1 (C1) walked out of the back door of his early head start classroom (classroom 3) which was left slightly ajar and to the older head start classroom's playground without being observed by the classroom staff.

During the course of the incident investigation, analyst conducted interviews with the site supervisor, the classroom teachers involved in the incident, a teacher who discovered the child on the playground and a witnessing administrative staff member. Analyst also reviewed related documentation regarding the incident and inspected the child's classroom and the play yard where he was found.

Based on information gathered, analyst determined that on day of incident staff members #1 and #2 (S1 and S2) were supervising a total of six day care children with S2 having specific one on one supervision of C1. At the time of the incident, S1 was supervising five children in the carpet area of the classroom and getting ready for them to transition to outdoor play while S2 was getting a broom on the classroom wall to sweep up and then was going to wipe down the classroom tables. The classroom back door had been left slightly propped open with a chair to let some air in the classroom when child C1 managed to open it and leave without being seen or heard by the staff members who were engaged in the noted activities.

Though, prior to leaving the classroom, a third staff member (S3) came to confirm the number of children present and ready to leave, she was advised by S1 that there were only five children leaving which was the number of children she was supervising rather than the six children present that day. S3's head count matched what S1 stated and C1 was not taken into account before transitioning outside.

C1 was found shortly after by another classroom teacher (S4) who was taking classroom 1 out to the head start playground and saw C1 in the yard by himself. When S4 attempted to get the child to bring him back in he started moving away from her, tripped and fell and sustained a slight injury to his lip. Child was brought to teacher S1 who treated the child by inspecting and rinsing his mouth. She then, after bringing child to the early head start play yard with other staff, reported the incident to the site supervisor.

Though the child was found in the gated older children's play yard and from all accounts did not seem to have any significant trauma from the incident or exposure to any hazards, from the testimony of all staff involved, it appeared the child was away from the classroom and without any visual supervision for anywhere from four to six minutes before it was discovered that he had left it.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Luigi Gargaro
LICENSING EVALUATOR SIGNATURE: DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/17/2024
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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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 - JOHN MARSHALL HEAD START
FACILITY NUMBER: 376600079
VISIT DATE: 12/17/2024
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A Type "A" violation was cited for the lapse in supervision by staff for the incident (see related 809D citation page). Appeal Rights (1/16) were discussed. Upon receipt of a type A violation, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. A copy of the report, appeal rights and the notice of site visit, that is to be posted for 30 days, was provided to site supervisor Rivero.
SUPERVISORS NAME: Jason Garay
LICENSING EVALUATOR NAME: Luigi Gargaro
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/19/2024 05:03 PM - It Cannot Be Edited


Created By: Luigi Gargaro On 12/17/2024 at 04:02 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 - JOHN MARSHALL HEAD START
FACILITY NUMBER: 376600079

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/17/2024
Section Cited
CCR
101229(a)(1)

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101229 Responsibility for Providing Care and Supervision (a)(1) - The licensee shall provide care and supervision ...No child(ren) shall be left without the supervision of a teacher at any time...

The requirement was not met as evidenced by:
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Director provided analyst with copies of the facility's 11/07/24, 11/08/24 and 12/18/24 in service training material for staff regarding appropriate supervision practices and expectations as well as the attendance sign in sheet for the training and other documentation regarding securing the classroom environment. Analyst will review documentation prior to final clearing of deficiency.
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Based on interviews and record reviews, a lack of supervision occurred for Child #1 (C1) during an 11/05/24 self-reported incident at the facility when he left his classroom by going through a propped open back door into a secured playground and was not discovered as missing for anywhere from four to six minutes by another classroom teacher coming on to the playground which posed an immediate Health and Safety risk to the child in care.
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Licensee was issued an immediate civil penalty for the lapse of supervision incident.

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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:Jason Garay
LICENSING EVALUATOR NAME:Luigi Gargaro
LICENSING EVALUATOR SIGNATURE:
DATE: 12/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/17/2024


LIC809 (FAS) - (06/04)
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