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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600310
Report Date: 08/18/2020
Date Signed: 08/18/2020 05:36:40 PM

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 ROTHGARD - PRESCHOOLFACILITY NUMBER:
376600310
ADMINISTRATOR:CELIA CARRIZOSAFACILITY TYPE:
850
ADDRESS:10130 ROTHGARD ROADTELEPHONE:
(619) 670-6566
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY:106CENSUS: 24DATE:
08/18/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Celia Carrizosa TIME COMPLETED:
02:00 PM
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On 08/18/20 at 1:00 p.m., Licensing Program Analyst (LPA), Rajani Goudreau conducted an unannounced case management – Incident tele-inspection. Upon visit, LPA met with Director, Celia Carrizosa. LPA toured the facility and verified facility was within ratio/capacity limitations.

On August 06, 2020, Director self- reported an incident regarding child #1 (C1) falling and obtaining a fractured left wrist while in care at the center on 08/05/20. LPA conducted interviews with the director and staff members. Based on interviews conducted and documentation submitted, facility was within ratio at time of incident. LPA was unable to conduct an interview with C1 due to not being in care at time of visit. LPA informed director to submit documentation relevant to incident. At this time the incident currently requires further investigation. The incident was reported to the Department in a timely manner..

No deficiencies issued during today’s inspection. An exit interview was conducted with Director. LPA discussed and will provide the following via email: LIC809, LIC9213-Notice of Site Visit and appeal rights. LPA informed Director upon receipt, LIC9213 shall be posted for 30 days from today’s date. COVID-19 State of emergency read receipt notification will be used in place of Directors signature
SUPERVISOR'S NAME: Jason GarayTELEPHONE: (619) 767-2250
LICENSING EVALUATOR NAME: Rajani GoudreauTELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2020
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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