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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700393
Report Date: 05/08/2024
Date Signed: 05/08/2024 04:16:42 PM

Document Has Been Signed on 05/08/2024 04:16 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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:LINDA VISTA STATE PRESCHOOLFACILITY NUMBER:
376700393
ADMINISTRATOR/
DIRECTOR:		NINA MAURICA-DIXONFACILITY TYPE:
850
ADDRESS:2772 ULRIC STREETTELEPHONE:
(858) 800-5450
CITY:SAN DIEGOSTATE: CAZIP CODE:
92111
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 35DATE:
05/08/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Miriam AtlasTIME VISIT/
INSPECTION COMPLETED:
04:35 PM
NARRATIVE
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On 5/8/24 at 2:00 PM, Licensing Program Analyst (LPA) Keturah Lane conducted an unannounced case management visit to follow up on an unusual incident regarding personal rights at the facility on 4/16/24. The incident was reported to licensing and the written report was received 4/21/24. LPA arrived at the facility at 10:00 AM for another reason and began the case management report at 2:00 PM. Upon arrival, LPA signed in at the office and introduced herself to the front staff. Principal Miriam Atlas greeted LPA and LPA explained the reason for the visit. LPA toured classroom #5 and spoke with special education teacher Ruth Pallais who was alone in the classroom. Ms. Pallais stated the children were on the playground and took LPA to playground. LPA observed a total of 17 children (AM Program) on the playground with substitute UTK teacher Eunice Sutherland and assistants Nina Earls, Anthony Rios and Jazmin Villa-Lobos.

LPA observed children transition from playground to lunch. This facility has an AM program and a PM program and is located on the elementar school campus of Linda Vista Elementary. The AM program children leave after lunch at 11:15 AM. There is a break of one hour in between programs and the PM program starts at 12:15 PM and ends at 3:15 PM. During the afternoon program, LPA observed a total of 18 children in the classroom with Substitute Teacher Eric Talner and assistants listed above.

During this visit, LPA interviewed 4 staff members and Principal Miriam Atlas who also provided a new director’s packet to LPA. The unusual incident reported involved a staff member (S1) who allegedly restrained a child (C1) at the cafeteria lunch table during lunch. The child was visibly upset and crying and was not allowed to be consoled by assistants during the lunch period. The incident was reported to the principal, who conducted an investigation. The parents were notified of the incident by a staff member and a meeting was held with the parents to discuss the incident. Based upon interviews with staff members, it was found that facility did not prevent or intervene to help the child who was being restrained by the staff member for approximately 20-25 minutes. See LIC809-D for Type A deficiency cited. (continued on LIC809-C...)

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE: DATE: 05/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/08/2024
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: LINDA VISTA STATE PRESCHOOL
FACILITY NUMBER: 376700393
VISIT DATE: 05/08/2024
NARRATIVE
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LPA Keturah Lane informed facility representative Miriam Atlas that this report dated 5/8/24 documents 1 Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Keturah Lane informed the facility representative to provide a copy of this licensing report dated 5/8/24 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 facility representative Miriam Atlas. Notice of site visit was provided and must be posted for 30 days.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Keturah Lane
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/08/2024 04:16 PM - It Cannot Be Edited


Created By: Keturah Lane On 05/08/2024 at 03:36 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: LINDA VISTA STATE PRESCHOOL
FACILITY NUMBER: 376700393

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/09/2024
Section Cited
CCR
101223.2(a)

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101223.2(a) Discipline
Any form of discipline or punishment that violates a child's personal rights as specified in Section 101223 shall not be permitted regardless of authorized representative consent or authorization. This requirement was not met as evidenced by…
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Principal stated she met with S1 and discussed personal rights of the child and held a meeting with parents and both teachers in the classroom regarding the incident. Principal also held individual trainings with staff members about how to report concerning incidents immediately and procedures to follow. Principal stated she would send documentation of the trainings with staff signature by 5/9/24 to LPA Lane via e-mail.
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Based upon numerous staff interviews and unusual incident reported to the Department from the facility, staff member (S1) restrained a child (C1) during lunch for over 20 minutes while the child was visibly upset which is an immediate health, safety and personal rights risk to children in care.
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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:Tashima Daniel
LICENSING EVALUATOR NAME:Keturah Lane
LICENSING EVALUATOR SIGNATURE:
DATE: 05/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/08/2024


LIC809 (FAS) - (06/04)
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