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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372005821
Report Date: 02/03/2023
Date Signed: 02/03/2023 10:35:49 AM


Document Has Been Signed on 02/03/2023 10:35 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:KINDERCARE LEARNING CENTER - TREENAFACILITY NUMBER:
372005821
ADMINISTRATOR:CELIDA BANUELOSFACILITY TYPE:
850
ADDRESS:10623 TREENA STREETTELEPHONE:
(858) 271-4700
CITY:SAN DIEGOSTATE: CAZIP CODE:
92131
CAPACITY:72CENSUS: 50DATE:
02/03/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Celida BanuelosTIME COMPLETED:
10:45 AM
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On 2/3/2023 @ 10:00AM, Licensing Program Analyst (LPA) conducted an unannounced case management inspection. LPA met with Celida Banuelos, Site Director. This inspection is in reference to a self-reported incident that occurred on 1/17/23 involving a 3-year old child who was playing on a play structure when he fell and injured his left shoulder. Child was taken to emergency immediately and was diagnosed with a fracture clavicle.

LPA interviewed staff Daniela Packard who witnessed the incident. She was standing approximately 6 feet away from the structure when she witnessed child climbing the play structure, missed a step and fell.

LPA observed that the play structure was age-appropriate for 2-5 years old. Sufficient cushioning was observed under the structure.

Appropriate actions were taken by staff and ensured that the child was immediately seen by a doctor.

NO DEFICIENCY CITED TODAY.

Exit interview was conducted with Ms. Banuelos. A copy of this report and appeal rights were provided today. Notice of site visit was observed posted and shall remain posted for 30 days.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Nancy DiazTELEPHONE: (619) 767-2207
LICENSING EVALUATOR SIGNATURE:
DATE: 02/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/03/2023
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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