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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600650
Report Date: 10/10/2023
Date Signed: 10/10/2023 11:56:29 AM


Document Has Been Signed on 10/10/2023 11:56 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 - CARLSBADFACILITY NUMBER:
376600650
ADMINISTRATOR:MELISSA RUIZFACILITY TYPE:
850
ADDRESS:1200 PLUM TREE ROADTELEPHONE:
(760) 435-0001
CITY:CARLSBADSTATE: CAZIP CODE:
92011
CAPACITY:125CENSUS: 84DATE:
10/10/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Melissa RuizTIME COMPLETED:
12:15 PM
NARRATIVE
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On 10/10/2023 @ 8:45 AM, Licensing Program Analyst (LPA), Adrian Mangina, made an unannounced visit to follow up on two self reported incidents that occurred on 9/28/23 and 10/2/23 respectively, wherein one child on each date sustained an injury. At the time of this inspection, there were 84 children in 11 classrooms with 11 teachers present. Proper ratio and supervision was observed.

LPA interviewed staff who responded to the incidents, obtained virtual sign-in-sheets, and inspected the areas of the incidents. LPA observed age-appropriate furnishings and equipment in both classrooms and no hazards were present. On 9/28/23 at the time of the first occurrence in classroom 2A there were 10 children with one teacher present. On 10/2/23 at the time of the second occurrence there were 7 children and one teacher in the classroom. Both children returned to the facility without restrictions on the next day following the incidents. Although facility staff responded appropriately, ratios were met, and direct supervision was in place, the facility failed to submit a verbal report within 24 hours of the incident on 9/28/23 and waited until 10/2/23 to submit a written report to Licensing.

See LIC809-D for deficiency cited.

Exit interview conducted and report was reviewed with the with Facility Representative, Melissa Ruiz. A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100. If additional citations are required regarding these incidents, LPA will return at a later date.
SUPERVISOR'S NAME: Renesha AskewTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Adrian L ManginaTELEPHONE: (619) 629-6197
LICENSING EVALUATOR SIGNATURE:
DATE: 10/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/10/2023
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 10/10/2023 11:56 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
FACILITY NUMBER: 376600650

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/10/2023
Section Cited
CCR
101212(d)

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REPORTING REQUIREMENTS: Upon the occurrence, ...child care center... events specified in (d)(1) ...report shall be made to the Department by telephone or fax within the Department's next working day...This requirement was not met as evidenced by:
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Based on interviews and record review facility did not comply with the requirement above as staff failed to verbally report injury requiring medical care within 24 hours as required which posed a potential health, safety, or personal rights risk to children in care.
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Based on interviews and record review facility did not comply with the requirement above as staff failed to verbally report injury requiring medical care within 24 hours as required which posed a potential health, safety, or personal rights 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: Renesha AskewTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Adrian L ManginaTELEPHONE: (619) 629-6197
LICENSING EVALUATOR SIGNATURE:
DATE: 10/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/10/2023
LIC809 (FAS) - (06/04)
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