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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372005150
Report Date: 10/31/2024
Date Signed: 10/31/2024 11:52:08 AM

Document Has Been Signed on 10/31/2024 11:52 AM - 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/
DIRECTOR:		TAMARA HOLTHAUSFACILITY TYPE:
850
ADDRESS:1140 WEST MISSION ROADTELEPHONE:
(760) 744-1150
CITY:SAN MARCOSSTATE: CAZIP CODE:
92069
CAPACITY: 108TOTAL ENROLLED CHILDREN: 79CENSUS: 62DATE:
10/31/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Director, Tamara HolthausTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
NARRATIVE
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On 10/31/24 Licensing Program Analyst (LPA) Saraliz Velando conducted an unannounced Case Management Incident Inspection to follow up on an unusual incident that occurred on 7/15/24. Upon arrival, LPA met with Director, Tamara Holthaus. There were 62 preschool children and 11 staff members present today.

The facility self-reported the incident to the Department by telephone on 7/19/24 and submitted the Unusual Incident Report on 7/19/24. The facility reported that a child had marks and scratches on his upper arms and the injuries were not observed. The facility was also reported to CPS. Based on file review, it was determined the incident was not reported timely.

Type B deficiency was cited on LIC809-D. Exit interview was conducted and report was reviewed with the Director, Tamara Holthaus. A notice of site visit was posted and must remain for 30 days.
SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Saraliz Velando
LICENSING EVALUATOR SIGNATURE: DATE: 10/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/31/2024
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 10/31/2024 11:52 AM - It Cannot Be Edited


Created By: Saraliz Velando On 10/31/2024 at 11:25 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: 10/31/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/15/2024
Section Cited
CCR
101212(d)

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101212(d) Reporting Requirements - (d)...during the operation of the child care center...a report shall be made to the Department by telephone or fax...submitted to the Department within seven days following the occurrence of such event. This requirement was not met by:
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The Director states that she will conduct a staff training to discuss reporting requirements for licensing and submit proof to the Dept by 11/15/24.
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Based on file review, the licensee did not call or fax the Department to report the unusual incident that occured on 7/15/24. The Department was notified on 7/19/24 and therefore posed a potential risk to the health and safety of 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: 10/31/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/31/2024


LIC809 (FAS) - (06/04)
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