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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600334
Report Date: 10/26/2022
Date Signed: 10/26/2022 10:05:15 AM


Document Has Been Signed on 10/26/2022 10:05 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501



FACILITY NAME:KINDERCARE COLLEGE INFANTFACILITY NUMBER:
376600334
ADMINISTRATOR:AUNICA DEFALCOFACILITY TYPE:
830
ADDRESS:3536 COLLEGE BLVD.TELEPHONE:
(760) 940-2008
CITY:OCEANSIDESTATE: CAZIP CODE:
92056
CAPACITY:36CENSUS: 15DATE:
10/26/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:14 AM
MET WITH:Assistant Director Wilma CabreraTIME COMPLETED:
10:11 AM
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On the date and time listed above, Licensing Program Analyst (LPA) Jeanette Sanchez arrived at the facility to conduct a case management visit. On 10/14/2022, the department received an Unusual Incident Report (UIR) regarding an incident on 10/14/2022, 7:10am, in which C1 bumped their head. LPA met with Assistant Director Wilma Cabrera.

LPA and Ms. Cabrera discussed the details and timeline of the incident. Ms. Cabrera explained that C1 ran to her while wearing non-grip socks, attempted to hug her from behind but fell back, causing C1 to bump their head on the non-carpeted floor. Upon picking up C1, Ms. Cabrera immediately noticed that C1 was not well. Ms. Cabrera instructed S1 to call 911 and S2 to call C1's parents. Per Ms. Cabrera, the paramedics arrived within 5 minutes and the parents arrived within 8 minutes. Paramedics waited for parents to arrive, observing C1 in the meantime. Paramedics gave parents the option to transport C1 to the hospital, but parents elected for ambulance transport.

Ms. Cabrera stated that a doctor at the hospital spoke with her to obtain incident details. Doctor cleared C1 to be released same day but parents elected for continued hospital observation. C1 returned to school on 10/17/2022 without restrictions or medical report. C1 has been consistently attending school without any observed concerns.

LPA observed area in which incident occurred as well as C1 playing in classroom. Ms. Cabrera said that it has been discussed with parents that C1 is unstable when walking/running. LPA observed this when Ms. Cabrera called C1 to her. Ms. Cabrera also mentioned that parents have been asked to provide socks with grip on the sole.
SUPERVISOR'S NAME: Stephanie HudakTELEPHONE: (951) 320-2021
LICENSING EVALUATOR NAME: Jeanette SanchezTELEPHONE: (951) 255-4577
LICENSING EVALUATOR SIGNATURE:
DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/26/2022
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 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: KINDERCARE COLLEGE INFANT
FACILITY NUMBER: 376600334
VISIT DATE: 10/26/2022
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LPA determined that the incident was not due to lack of supervision and that immediate medical attention was provided to C1.

There are no deficiencies at this time.

An exit interview was conducted, and this report was reviewed with Assistant Director Wilma Cabrera. Appeal rights were discussed and provided during the exit interview.

A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Stephanie HudakTELEPHONE: (951) 320-2021
LICENSING EVALUATOR NAME: Jeanette SanchezTELEPHONE: (951) 255-4577
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
LIC809 (FAS) - (06/04)
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