<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372000455
Report Date: 09/28/2022
Date Signed: 09/28/2022 03:27:35 PM


Document Has Been Signed on 09/28/2022 03:27 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:PILGRIM DAY CARE CENTERFACILITY NUMBER:
372000455
ADMINISTRATOR:J. GOINS & C. O'CONNORFACILITY TYPE:
850
ADDRESS:2020 CHESTNUT AVENUETELEPHONE:
(760) 729-4464
CITY:CARLSBADSTATE: CAZIP CODE:
92008
CAPACITY:110CENSUS: 47DATE:
09/28/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:13 PM
MET WITH:J. Goins & C. O'ConnorTIME COMPLETED:
01:20 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 09/28/2022 at 12:13pm, Licensing Program Analyst (LPA) Samantha Clenista conducted an unannounced case management site inspection to follow up on a self-reported incident that occurred on 09/16/2022.

Upon arrival, LPA met with Co Directors, Jennifer Goins & Colleen O'Connor, and proceeded to tour the facility. There was a total of 47 children with a total of 11 staff members. Children in care were observed napping or getting ready for nap. All required notices, forms and licenses were posted. Furniture and age appropriate equipment indoors was observed in good condition. Rooms have adequate heating, lighting, and ventilation.

On 09/23/2022, facility reported that Child #1 sustained a cut on his forehead from tripping as he was walking across the bridge of a climbing structure located in the facility’s small sandy playground. Child #1 hit his forehead on a rounded screw that connects the bridge to the structure. Staff immediately applied TLC to the wound and contacted Child #1’s parent to have him get picked up and checked. During inspection, LPA observed where the incident occurred and interviewed primary witness. Play structure was observed to be safe, age appropriate and free of hazards. LPA took pictures of the play structure and the nail where Child #1 hit his forehead. Area appeared to be in good repair. Facility has placed a rug over the nails that are located on the bridge area of the structure for extra cushion.

Based on information gathered, the facility acted appropriately, and no violations have been identified. LPA reviewed this report with Director's at conclusion of visit. Due to printer malfunction, LPA will email a copy of the Notice of Site Visit form, this report and facility's appeal rights to Director's by COB today. Director's state they understand that the NOS shall be posted and remain posted for 30 consecutive days.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Samantha ClenistaTELEPHONE: (619) 818-6740
LICENSING EVALUATOR SIGNATURE:
DATE: 09/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/28/2022
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 1