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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701392
Report Date: 05/23/2024
Date Signed: 05/23/2024 09:17:07 AM

Document Has Been Signed on 05/23/2024 09:17 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:AKA HEAD START - JACKMANFACILITY NUMBER:
376701392
ADMINISTRATOR/
DIRECTOR:		ANGELA CARROLLFACILITY TYPE:
850
ADDRESS:832 JACKMAN STREETTELEPHONE:
(619) 334-4444
CITY:EL CAJONSTATE: CAZIP CODE:
92020
CAPACITY: 64TOTAL ENROLLED CHILDREN: 64CENSUS: 42DATE:
05/23/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:20 AM
MET WITH:Angela TIME VISIT/
INSPECTION COMPLETED:
09:30 AM
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On 5/23/24 at 8:20 AM Licensing Program Analyst (LPA), Annette Sutherland, conducted a case management visit for the purpose of following up on a self-reported incident that occurred 4/26/24 when a child fell off low height slide onto padded turf and was injured.
Present today were a total of 42 children and 17 staff.

LPA toured the facility and interviewed Site Director, Anglea Carroll and staff present the day of the incident. Playground area was observed to get clarification on what happened and where it occurred. At the time of the incident the program was within staff to child ratio requirements 1:4. Playground has sufficient cushioning and proper supervision was in place at the time.

No deficiencies cited today.

NOTICE OF SITE VISIT IS TO BE POSTED FOR 30 DAYS. LPA observed Director Anglea Carroll post notice of site visit.
SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Annette Sutherland
LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2024
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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