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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701203
Report Date: 12/13/2023
Date Signed: 12/13/2023 03:46:27 PM

Document Has Been Signed on 12/13/2023 03:46 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:HILLSIDE VILLAGE HEAD START CHILD DEVELOPMENTFACILITY NUMBER:
376701203
ADMINISTRATOR:TANIA BELLOFACILITY TYPE:
850
ADDRESS:12979A COMMUNITY ROADTELEPHONE:
(858) 486-1284
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 11DATE:
12/13/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Tania BelloTIME COMPLETED:
04:00 PM
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On 12/13/23 at 1:30 PM Licensing Program Analyst (LPA), Adrian Mangina conducted an unannounced visit to follow up on a self-reported incident that occurred on 12/4/23 at approximately 3:45 PM wherein child #1 was running and playing with child #2 when child #2 reached out and accidentally pushed child 1 down causing child #1 to hit head and require emergency medical assistance from paramedics. Census during this visit was 11 napping children with 5 teachers and one instructional aide in 2 classrooms. Proper ratios and supervision were observed.

During the visit, LPA obtained the following documents: ouch report for child 1, sign in sheets for 12/4/23, child roster, and updated LIC624. LPA also interviewed witnesses. LPA interviewed Site Director Tania Bello who stated that there was a teacher and an instructional aide supervising 6 children children outside. LPA interviewed both staff present when the incident occurred. Staff #1 witnessed the incident from the second tier of a play structure. Staff 1 was on the play structure assisting three children slide and climb and was also watching child 1 and child 2 as the children ran around on the astroturf. The children were running on the only area outside where running is allowed as there is adequate cushioning under the play structure to help prevent injuries. Child 2 was pretending to be a dinosaur and playfully grabbed child 1 causing that child to fall. Staff 1 immediately provided care to the child as Staff 2 took over supervision of the children until more staff could arrive. Staff 2 did not witness the incident but heard the child cry and called to another teacher to get the Site Director’s attention. Site Director called paramedics and parents and the child was transported to the hospital for further care. The child was medically cleared with restrictions to return to the facility 48 hours later.

Supervision was in place, ratios were met, the facility responded appropriately and reported timely. This appears to be a random accident. No deficiencies are cited.

Exit interview conducted and report was reviewed with the facility representative Tania Bello. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2023
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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