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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600311
Report Date: 02/05/2020
Date Signed: 02/05/2020 05:49:48 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 - INFANTFACILITY NUMBER:
376600311
ADMINISTRATOR:ELLE JACKSONFACILITY TYPE:
830
ADDRESS:10130 ROTHGARD ROADTELEPHONE:
(619) 670-6566
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY:23CENSUS: 12DATE:
02/05/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Celia CarrizosaTIME COMPLETED:
03:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Vicky Williamson conducted a case management inspection. Upon arrival, LPA met with Director, Celia Carrizosa and proceeded to tour the facility. There were 8 infants present with 1 teacher and 1 aide. The toddler classroom had 4 toddlers present with 1 teacher. On 1/24/20, Per interviews conducted with staff and verification of Children Supervision Record (CSR), the ratio was 2:9 between the hours of 7:31 am – 8:10 am, resulting in the facility operating out of ratio in the infant classroom. Director failed to self-report the unusual incident to Community Care Licensing (CCL). Director stated that she was unaware that a classroom operating out of ratio should be reported. LPA and the director discussed reporting requirements. Director was provided with the duty line information. Duty Line operates Monday – Friday, 8:00 am – 5:00 pm, (619) 767-2248

See 809D for cited deficiency. AB 633 requires that a copy of this report be posted and provided to parents of all children currently enrolled and parents of newly enrolled children in the next 12 months. Signed receipt (LIC 9224) to be maintained in each child's record for future review by Licensing staff. Form LIC 9224 was given to licensee.

A Technical Assistance was issued. Director was provided the appeal rights (LIC9058 01/16) and the signature on this form acknowledges receipt of these rights. Notice of Site Visit was provided and is to be posted for 30 days. LPA observed Director post notice of site visit.
SUPERVISOR'S NAME: Joe CarrascoTELEPHONE: (619) 767-2243
LICENSING EVALUATOR NAME: Vicky WilliamsonTELEPHONE: (619) 767-2214
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2020
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 - INFANT
FACILITY NUMBER: 376600311
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/05/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/19/2020
Section Cited

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There shall be a ratio of one teacher for every four infants in attendance. Requirement was not
met as evidenced by: Interviews conducted with staff indicating that the facility was operating out of ratio on 1/24/20 and verification of Children Supervision Record (CSR).
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It was determined that the facility operated a 2:9 ratio between the morning hours of 7:31 am – 8:10 am, resulting in the facility operating out of ratio in the infant This poses an immediate health and safety risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Joe CarrascoTELEPHONE: (619) 767-2243
LICENSING EVALUATOR NAME: Vicky WilliamsonTELEPHONE: (619) 767-2214
LICENSING EVALUATOR SIGNATURE:
DATE: 02/05/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/05/2020
LIC809 (FAS) - (06/04)
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