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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600344
Report Date: 12/05/2022
Date Signed: 01/25/2023 10:15:01 AM


Document Has Been Signed on 01/25/2023 10:15 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 01/11/2023 10:03 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

NARRATIVE
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This is an amended report . On 12/5/22 LPA Annette Sutherland was at the facility for an inspection concerning another matter. LPA toured facility and took a census. LPA was unable to locate staff #1 on association list. Licensee was unable to provide proof of association .

A civil penalty and Type B deficiency cited on LIC 809D

An exit interview was conducted with the Director. Notice of Site Visit (LIC 9213, Appeal Rights (LIC 9058) and a copy of the report (LIC809) was provided to Director .The Notice of Site Visit was posted during todays visits. Notice of site Visit must remain posted for 30 days.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Annette SutherlandTELEPHONE: (619) 629-8751
LICENSING EVALUATOR SIGNATURE:
DATE: 12/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/05/2022
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


Document Has Been Signed on 01/25/2023 10:16 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 01/11/2023 10:07 AM

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 PASEO MONTRIL INFANT
FACILITY NUMBER: 376600344

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/05/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/05/2022
Section Cited

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This is an amended report. 101216 (i)(2) Personnel Requirements: Request a transfer of a criminal record clearance as specified in Section 101170(f). This requirement was not met as evidence by:
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Director will associate staff to infant program and submit proof by POC date of 12/6/22. Proof will be maintained in staff file. A civil penalty was assessed.
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Based on observation and record review. Staff #1 is clear but not associated to the preschool program. This posses an potential risk to the health and safety of the 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: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Annette SutherlandTELEPHONE: (619) 629-8751
LICENSING EVALUATOR SIGNATURE:
DATE: 12/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/05/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2