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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701118
Report Date: 11/08/2023
Date Signed: 11/08/2023 12:22:06 PM


Document Has Been Signed on 11/08/2023 12:22 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:MAAC EARLY HEAD START - WESTLAKEFACILITY NUMBER:
376701118
ADMINISTRATOR:LEILA EBTEKARIFACILITY TYPE:
830
ADDRESS:415 AUTUMN DRIVETELEPHONE:
(760) 631-2695
CITY:SAN MARCOSSTATE: CAZIP CODE:
92069
CAPACITY:18CENSUS: 11DATE:
11/08/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Leila EbtekariTIME COMPLETED:
12:35 PM
NARRATIVE
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On November 8, 2023 at 10:20 a.m. Licensing Program Analyst (LPA) Leilani Curtis conducted an unannounced inspection to follow up on a self-reported incident that occurred on 10/26/23, wherein a substitute staff member (S1) withheld food from a child (C1). Upon arrival LPA met with Director Leila Ebtekari and toured the facility. There were 11 children with 6 staff members present. Appropriate ratio/capacity was observed. Staff members have the required background clearances and are associated to the facility.

LPA interviewed the director, staff #2 (S2) and staff #3 (S3). On 10/26/23 at approximately 11:00 a.m. during meal time, child #1 (C1) threw food on the floor. Staff #1 (S1) took C1’s food away and advised C1 that the food would be returned when C1 "was ready". Staff #2 (S2) intervened and assisted C1. S2 advised S1 that using negative and threatening language, and withholding food cannot be used to correct a child’s behavior. At the time of the incident there were 3 children present with S1 in classroom #2. Appropriate ratio and supervision was in place. The incident was reported to Community Care Licensing timely and the director states that the parent/guardian of C1 was notified of the incident the same day. The agency that employs S1 was notified of the incident and S1 will not return to the facility as a substitute staff member. The director also states that a staff meeting was held on 10/27/23 to discuss children’s personal rights and supervision. They also discussed the importance of ensuring that substitute staff understand how to protect the rights of children.

See LIC809D for cited deficiency.

An exit interview was conducted with Director Ebtekari and Appeal Rights (LIC 9058) were discussed. The director’s signature on this form acknowledges receipt of these rights. LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS. LPA observed the director post notice of site visit.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace CurtisTELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:
DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2023
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 2


Document Has Been Signed on 11/08/2023 12:22 PM - It Cannot Be Edited

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: MAAC EARLY HEAD START - WESTLAKE
FACILITY NUMBER: 376701118

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/08/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/15/2023
Section Cited
CCR
101223(a)(3)

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101223 Personal Rights:(a) The licensee shall ensure that each child is accorded the following personal rights: (3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature...This requirement was not met as evidenced by:
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The director states that she will send LPA a signed and dated statement detailing how she will ensure that facility staff do not violate the rights of children in care. The director states that she will send the statement to LPA via email by 11/15/23.
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Based on staff interviews and record review, the personal rights of child #1 (C1) were violated on 10/26/23 when S1 removed C1's food/plate as a way of correcting the child's behavior. This poses a potential health, safety or personal rights risk to the 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 DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace CurtisTELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:
DATE: 11/08/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2023
LIC809 (FAS) - (06/04)
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