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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372005150
Report Date: 03/13/2024
Date Signed: 03/13/2024 03:08:12 PM

Document Has Been Signed on 03/13/2024 03:08 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:PALOMAR COMMUNITY COLLEGE DISTRICT ECE LAB SCHOOLFACILITY NUMBER:
372005150
ADMINISTRATOR:TAMARA HOLTHAUSFACILITY TYPE:
850
ADDRESS:1140 WEST MISSION ROADTELEPHONE:
(760) 744-1150
CITY:SAN MARCOSSTATE: CAZIP CODE:
92069
CAPACITY: 108TOTAL ENROLLED CHILDREN: 110CENSUS: 80DATE:
03/13/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Site Supervisor, Claribel ZorillaTIME COMPLETED:
10:30 AM
NARRATIVE
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On 3/13/24, Licensing Program Analyst (LPA) Saraliz Velando conducted an unannounced case management visit to follow up on an incident report that occurred on 2/23/24. Upon arrival, LPA met with Site Supervisor, Claribel Zorrilla. There were 16 staff and 80 preschool children in care.

The facility self-reported the incident to the department on 3/1/24. During the incident a preschool child was found crying in the storage closet of their classroom by a teacher and reunited back with their class. According to staff, the child was missing for approximately 5-7 minutes.

The staff was interviewed and based on the information, it appears that the Face-to-Name procedure was not followed properly during the incident, resulting in failure to visually supervise the child.

Type B Violation was cited. Refer to the next page LIC 809-D for deficiency citation.

Exit interview was conducted and report was reviewed with Site Supervisor, Claribel Zorrilla. A copy of the report and the Appeal Rights was provided. A notice of site visit was posted and shall remain posted for 30 days.
SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Saraliz Velando
LICENSING EVALUATOR SIGNATURE: DATE: 03/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2024
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 2
Document Has Been Signed on 03/13/2024 03:08 PM - It Cannot Be Edited


Created By: Saraliz Velando On 03/13/2024 at 11:12 AM
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: PALOMAR COMMUNITY COLLEGE DISTRICT ECE LAB SCHOOL
FACILITY NUMBER: 372005150

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/13/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/22/2024
Section Cited
CCR
101229(a)(1)

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RESPONSIBILITY FOR PROVIDING CARE AND SUPERVISION(1) No child(ren) shall be left without the supervision... Supervision shall include visual observation.
This requirement was not met as evidenced by:
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Site Supervisor stated she will have a training on the importance of face to name procedure and active supervision and will submit proof to the dept by 3/22/24.
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Based on staff interviews the facility failed to provide visual supervision resulting in a child was left alone in the storage closet of classroom #3. 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:Joelle Redding
LICENSING EVALUATOR NAME:Saraliz Velando
LICENSING EVALUATOR SIGNATURE:
DATE: 03/13/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/13/2024


LIC809 (FAS) - (06/04)
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