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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600278
Report Date: 12/01/2022
Date Signed: 12/01/2022 10:59:11 AM

Document Has Been Signed on 12/01/2022 10:59 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
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:MAAC GOSNELLFACILITY NUMBER:
376600278
ADMINISTRATOR:SARA GIBBSFACILITY TYPE:
850
ADDRESS:139 GOSNELL WAYTELEPHONE:
(760) 736-3066
CITY:SAN MARCOSSTATE: CAZIP CODE:
92069
CAPACITY: 112TOTAL ENROLLED CHILDREN: 112CENSUS: 50DATE:
12/01/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Sara GibbsTIME COMPLETED:
09:29 AM
NARRATIVE
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On December 1, 2022 at 8:25 a.m. Licensing Program Analyst, Leilani Curtis, conducted an unannounced inspection to follow up on a self-reported incident that occurred on 11/15/22, wherein a 3-year-old child (C1) was left unattended on the playground. LPA met with Director Sara Gibbs and proceeded to tour the facility. There were 50 children with 17 staff members present. Appropriate ratio/capacity was observed. Staff members have the required background clearances. All staff members are associated to the facility except for staff member Najat Abid Matti. The director states that today, 12/1/22, is Ms. Matti's first day at the facility.

LPA interviewed the director and staff #1 (S1) via telephone from the facility. On 11/15/22 at approximately 4:22 p.m. S1 was supervising four children on the playground. The parent/guardian of three of those children picked up and signed their children out. S1 cleaned the playground and went back to her classroom at approximately 4:46 p.m. without the remaining child. The parent of C1 arrived at the facility and found her child alone on the playground. The parent (P1) took C1 to the classroom and signed the child out at 4:31 p.m. P1 advised the center director of the incident the next day, 11/16/22. C1 was not injured. The director and S1 state that P1 was able to retrieve her child from the playground because the perimeter facility gate is not locked during the day. P1 entered the facility unannounced, picked up her child and took him to the classroom. The director states that she met with the parent and the staff member regarding the incident. On 11/19/22 S1 was provided training on active supervision, and proper procedures to ensure that children are never left unattended. After the individual meeting with S1 a meeting was also held on 11/19/22 for all staff to discuss supervision. The director provided LPA with a copy of S1’s written statement about the incident and other confidential information.

See LIC809D for cited deficiency. A civil penalty has been assessed.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Grace Curtis
LICENSING EVALUATOR SIGNATURE: DATE: 12/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/01/2022
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 4
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 GOSNELL
FACILITY NUMBER: 376600278
VISIT DATE: 12/01/2022
NARRATIVE
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LPA Curtis informed Director Gibbs that this report dated 12/1/22 documents one Type A citation. A Type A citation must be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

Also, LPA Curtis informed Director Gibbs to provide a copy of this licensing report dated 12/1/22 that documents a Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

An exit interview was conducted with the director 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.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Grace Curtis
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2022
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 12/01/2022 10:59 AM - It Cannot Be Edited


Created By: Grace Curtis On 12/01/2022 at 09:46 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: MAAC GOSNELL
FACILITY NUMBER: 376600278

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/01/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/02/2022
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision: (a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement was not met as evidenced by:
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The director states that she will meet with all staff members regarding supervision. The staff members will submit a signed statement detailing appropriate supervision requirements and procedures. The director will send the statements to LPA via email by 12/2/22.
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Based on interviews with S1 and the director, C1 was left unattended on the playground on 11/15/22. This poses an immediate health and safety risk to 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 Daniel
LICENSING EVALUATOR NAME:Grace Curtis
LICENSING EVALUATOR SIGNATURE:
DATE: 12/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/01/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/01/2022 10:59 AM - It Cannot Be Edited


Created By: Grace Curtis On 12/01/2022 at 10:23 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: MAAC GOSNELL
FACILITY NUMBER: 376600278

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/01/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/02/2022
Section Cited
CCR
101170(e)(2)

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101170(e)(2): Criminal Record Clearance (e)All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:(2) Request a transfer of a criminal record clearance as specified in Section 101170(f)...This requirement was not met as evidenced by:
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The director states that she will send verification to LPA via email that staff member Najat Abid Matti has been associated to the facility by 12/2/22.
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Based on record review, staff member Najat Abid Matti has a criminal record clearance but is not associated to the facility. This poses a potential health and safety 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 Daniel
LICENSING EVALUATOR NAME:Grace Curtis
LICENSING EVALUATOR SIGNATURE:
DATE: 12/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/01/2022


LIC809 (FAS) - (06/04)
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