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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600650
Report Date: 02/23/2024
Date Signed: 02/23/2024 03:39:31 PM


Document Has Been Signed on 02/23/2024 03:39 PM - 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: 75DATE:
02/23/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Kayla Mills, Assistant Director TIME COMPLETED:
04:00 PM
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On 2/23/2024, Licensing Program Analyst (LPA) Patrick Ma, made an unannounced Case Management inspection regarding self-reported incident made on 2/16/2024. LPA met with Assistant Director (AD), Kayla Mills. During this visit, LPA interviewed staff, inspected outdoor play equipment, made a confidential names list, and reviewed related documents.

AD verified incident as reported to Department. Staff S1 observed child C1 playing on outdoor playground structure. C1 was asked to climb down but jumped instead and was injured. C1 was immediately attended to by staff and family was notified. Play structure was inspected and found in good repair, ground cushioning meets regulations, and appropriate ratios were in place at time of incident.

No deficiency is cited.

Exit interview conducted and report was reviewed with the facility representative Kayla Mills. A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Renesha AskewTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Patrick MaTELEPHONE: (619) 767-2218
LICENSING EVALUATOR SIGNATURE:
DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/23/2024
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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