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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600648
Report Date: 08/05/2022
Date Signed: 08/05/2022 11:01:41 AM


Document Has Been Signed on 08/05/2022 11:01 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, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108



FACILITY NAME:KINDERCARE - CARLSBAD INFANT CENTERFACILITY NUMBER:
376600648
ADMINISTRATOR:CORRIE BARRICKFACILITY TYPE:
830
ADDRESS:1200 PLUM TREE ROADTELEPHONE:
(760) 435-0001
CITY:CARLSBADSTATE: CAZIP CODE:
92011
CAPACITY:43CENSUS: 6DATE:
08/05/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Director Melissa RuizTIME COMPLETED:
11:00 AM
NARRATIVE
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On 8/5/22 @ 10:15 a.m. Licensing Program Analyst (LPA), Joelle Redding, made an unannounced visit to discuss the circumstances surrounding a self reported incident that occurred on 6/29/22 wherein a staff member fed a partially consumed, day old bottle to an infant in care.

Based on interviews with Director and staff today, staff did not verify the date on the bottle prior to feeding it to the infant. There was a switch of staff part way though the feeding it was assumed the date was verified. Although it was determined that the child's mother repacked a half consumed bottle from the day before and provided it to the facility for the child to use, it is still the facility's staff's responsibility to check the label and name prior to feeding. The incident was reported to the parent and no ill effects occurred.

A Type B deficiency will be cited on the accompanying LIC 809D. Appeal rights were discussed and provided. Notice of Site Visit was posted and will remain posted for 30 days.
SUPERVISOR'S NAME: Renesha AskewTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 08/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/05/2022
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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Document Has Been Signed on 08/05/2022 11:01 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
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108


FACILITY NAME: KINDERCARE - CARLSBAD INFANT CENTER
FACILITY NUMBER: 376600648

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/05/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/19/2022
Section Cited

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Personnel Requirements. Child care center personnel shall be competent to provide the services necessary to meet the individual needs of children in care...

This requirement was not met as evidenced by:
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Based on interviews, it was determined that staff members did not verify the correct date on a bottle of formula before feeding an infant. This resulted in a child being fed a partially consumed, day old bottle that had been repacked by the child's mother. This is a potential risk to the health and safety of children in care.
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No further correction is being required by Licensing today.

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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: Renesha AskewTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 08/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/05/2022
LIC809 (FAS) - (06/04)
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