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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600310
Report Date: 12/22/2021
Date Signed: 12/22/2021 10:37:59 AM

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: 53DATE:
12/22/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Celia Carrizosa TIME COMPLETED:
10:45 AM
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On 12/22/21 at 9:30 a.m., Licensing Program analyst (LPA), Rajani Goudreau made an unannounced Case Management inspection to follow up on an incident that was self-reported to the department on 12/03/21. Upon arrival, LPA met with the director, Celia Carrizosa and disclosed the purpose of the inspection and proceeded to tour the facility. The following ratios were observed: 53 children with eight staff members present. Facility operates Monday through Friday from 6:00 a.m. to 6:00 p.m.

The facility reported an incident that occurred on December 03,2021 regarding a collision involving the facility school bus. One staff member was transporting two children back to the facility from school pick up at the time of the incident. The initial incident follow-up was conducted on December 07, 2021. LPA conducted interviews with staff members and children in care involved in the incident and reviewed documents related to the incident. Based on the information obtained there were no violations.

No deficiencies issued during today's visit. LPA conducted an exit interview with the director. LPA discussed and provided the following to the director: LIC809, LIC9213-Notice of Site Visit, and Appeal Rights. LPA informed the director the Notice of Site Visit shall be posted for 30 days from today's date.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Rajani GoudreauTELEPHONE: (619) 767-2215
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021
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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