<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600992
Report Date: 05/09/2024
Date Signed: 05/09/2024 11:01:51 AM

Document Has Been Signed on 05/09/2024 11:01 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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:NHA URBAN VILLAGE II HEAD STARTFACILITY NUMBER:
376600992
ADMINISTRATOR/
DIRECTOR:
BRENDA PATTYFACILITY TYPE:
850
ADDRESS:4305 UNIVERSITY AVENUE STE 107TELEPHONE:
(619) 284-5644
CITY:SAN DIEGOSTATE: CAZIP CODE:
92105
CAPACITY: 88TOTAL ENROLLED CHILDREN: 88CENSUS: 46DATE:
05/09/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Director Brenda PattyTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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 May 9th, 2024, at 10:15 AM, Licensing Program Analyst (LPA) Jo Ann Legaspi conducted a case management inspection to follow-up on an incident that occurred on 05/02/2024. LPA advised Director Brenda Patty of the meeting’s purpose and was granted facility entry. Director Patty provided LPA with a facility tour.

A child became unresponsive during morning circle time on 05/02/2024. The child was transported via ambulance to the hospital on 05/02/2024. They returned to care on 05/06/2024. The incident was self reported by the facility. There were 13 children with 3 staff during the incident. On 05/02/2024, the child arrived at the facility at about 8:30 AM. During circle time at about 9 AM, a child fainted and became unresponsive. Staff contacted the parents and ambulance who transported them to the hospital. Staff members reported that the child's behavior was inconsistent with his normal behavior on the incident morning. Staff further stated that upon arrival on the incident morning, the child ate cereal and melons, which he had previously eaten sans issue in the past. LPA inspected the classroom and observed that the equipment and furniture is age-appropriate. There were no apparent hazards accessible to children. The parent related that the child developed their condition, which resulted in the incident, outside of the facility. No deficiencies cited.

A notice of site visit was given to facility representative and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Licensee/Appeal Rights (LIC 9058) was provided to Director Brenda Patty. Exit interview conducted and report was reviewed with the facility representative Director Brenda Patty.

SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: JoAnn R Legaspi
LICENSING EVALUATOR SIGNATURE: DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1