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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370806089
Report Date: 04/06/2022
Date Signed: 04/06/2022 03:31:53 PM

Document Has Been Signed on 04/06/2022 03:31 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:AKA HEAD START - FARRAGUT CIRCLEFACILITY NUMBER:
370806089
ADMINISTRATOR:GLORIA SANCHEZFACILITY TYPE:
850
ADDRESS:490 FARRAGUT CIRCLETELEPHONE:
(619) 593-8010
CITY:EL CAJONSTATE: CAZIP CODE:
92020
CAPACITY: 104TOTAL ENROLLED CHILDREN: 114CENSUS: 50DATE:
04/06/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:33 PM
MET WITH:Assistant Director, Leena SaeedTIME COMPLETED:
03:40 PM
NARRATIVE
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On 04/06/22, Licensing Program Analysts (LPAs), Saraliz Velando and Selina Siao, conducted a Case Management inspection to follow up on a self- reported incident that happened on 02/17/2022. The initial inspection was conducted on 03/02/2022. Present at the facility were 50 children with 8 staff members. Appropriate ratios were observed during the inspection and all staff members have the required background clearances and are associated to the facility.

Based on information obtained from the facility, records reviewed, and interviews conducted, it was determined that a staff person violated the Personal Rights of a child by placing her foot on a child’s neck.

Refer to the next page LIC 809D for type B deficiencies citations. An exit interview was conducted, and appeal rights were provided. A notice of site visit was provided, and it must be posted at the facility for 30 days. Failure to keep notice posted will result in a civil penalty of $100.00.
SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Saraliz Velando
LICENSING EVALUATOR SIGNATURE: DATE: 04/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/06/2022
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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Document Has Been Signed on 04/06/2022 03:31 PM - It Cannot Be Edited


Created By: Saraliz Velando On 04/06/2022 at 02:51 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: AKA HEAD START - FARRAGUT CIRCLE
FACILITY NUMBER: 370806089

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/06/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/06/2022
Section Cited
CCR
101223(a)(3)

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Personal Rights: 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 including but not limited to interference with functions of daily living including eating, sleeping ... to physical functioning. This requirement was not met as evidence by:
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Assistant director stated that training was provided with all staff members on 3/4/22 regarding Children's Rights Violation- Zero Tolerance. A copy of the Agenda, training, and sign-in sheet was obtained today.
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Based on information obtained from the facility, records reviewed and interviews conducted, a staff person violated the Personal Rights of a child by placing her foot on a child’s neck on 2/17/22. This poses a potential health and safety risk for children in care.



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CCR

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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:Monica Cuddy
LICENSING EVALUATOR NAME:Saraliz Velando
LICENSING EVALUATOR SIGNATURE:
DATE: 04/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/06/2022


LIC809 (FAS) - (06/04)
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