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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600362
Report Date: 04/19/2024
Date Signed: 04/19/2024 11:03:22 AM


Document Has Been Signed on 04/19/2024 11:03 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
SAN DIEGO NORTH, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108



FACILITY NAME:KINDERCARE AGEE INFANTFACILITY NUMBER:
376600362
ADMINISTRATOR:JEMIMA GREYFACILITY TYPE:
830
ADDRESS:6150 AGEE STREETTELEPHONE:
(858) 453-7530
CITY:SAN DIEGOSTATE: CAZIP CODE:
92122
CAPACITY:32CENSUS: 17DATE:
04/19/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:41 AM
MET WITH:Jemima GreyTIME COMPLETED:
11:15 AM
NARRATIVE
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On April 19, 2024 @ 9:41AM, Licensing Program Analysts (LPAs) Sherlynn Banas and Nancy Diaz conducted an unannounced case management inspection.

LPAs toured the facility with Madeline Howerton, Ass't Director. Observed present were 17 infants and toddlers with 7 staff.

In the process of reviewing fingerprint clearance association, there were 3 staff that were not associated to the facility.

Deficiency was cited and civil penalty assessed.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 629-8413
LICENSING EVALUATOR NAME: Sherlynn BanasTELEPHONE: (619) 629-8368
LICENSING EVALUATOR SIGNATURE:
DATE: 04/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/19/2024
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 04/19/2024 11:03 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO NORTH, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108


FACILITY NAME: KINDERCARE AGEE INFANT
FACILITY NUMBER: 376600362

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/19/2024
Section Cited
CCR
101170(e)(2)

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Criminal Record Clearance
All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility. Request a transfer of a criminal record clearance..
THIS REQUIREMENT WAS NOT MET AS EVIDENCED BY:
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Ms. Howerton stated that she will associate the 3 staff on Guardian effective by end of business day of 4/19/2024.
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Based on LPA's review of the fingeprint association database, 3 staff were not associated with the infant license. These staff were associated to the preschool license.
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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: Tashima DanielTELEPHONE: (619) 629-8413
LICENSING EVALUATOR NAME: Sherlynn BanasTELEPHONE: (619) 629-8368
LICENSING EVALUATOR SIGNATURE:
DATE: 04/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/19/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2