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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600650
Report Date: 10/18/2024
Date Signed: 10/18/2024 12:13:55 PM


Document Has Been Signed on 10/18/2024 12:13 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:AMANDA "MANDY" HERNANDEZFACILITY TYPE:
850
ADDRESS:1200 PLUM TREE ROADTELEPHONE:
(760) 435-0001
CITY:CARLSBADSTATE: CAZIP CODE:
92011
CAPACITY:125CENSUS: DATE:
10/18/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Lorena Arizaga and Kayla MillsTIME COMPLETED:
12:30 PM
NARRATIVE
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On 10/18/24 at 10:25am, LPA Patrick Ma made an unannounced case management visit for the purpose of following up on a self reported incident. Upon arrival, LPA met with Program Specialist, Lorena Arizaga and Assistant Director, Kayla Mills. Director was not present at facility. LPA inspected facility area of incident, conducted staff interviews, and made a confidential names list.

Based on staff interviews, after staff S1 transitioned their class from the playground back inside the facility, after about 10 minutes, staff S2 observed through the playground door window child C1 alone in the pass through classroom with the doors closed. S2 immediately brought C1 to join her class and contacted management. S1 failed to correctly follow facility policy to conduct name to face checks during outdoor-to-indoor transition.

Exit interview conducted and report was reviewed with the facility representative Lorena Arizaga. 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: 10/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2024
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 10/18/2024 12:13 PM - 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: 10/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/18/2024
Section Cited
CCR
101229(a)(1)

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101229(a)(1) No child(ren) shall be left without the supervision of a teacher at any time….Supervision shall include visual observation. This requirement was not met as evidenced by:
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Facility representative stated she will have S1 review CDSS Child Care Licensing Providers Resource instructional video: https://ccld.childcarevideos.org/child-care-center-operators/ Supervising Children in Child Care Centers and provide a written summary of the video to the Department by 11/18/24.
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Based on staff interviews, staff S1 did not have visual supervision of child C1 for about 10 minute before staff S2 observed C1 alone in a classroom which posed a potential health, safety or personal rights risk to child 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: Patrick MaTELEPHONE: (619) 767-2218
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2024
LIC809 (FAS) - (06/04)
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