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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600650
Report Date: 02/14/2022
Date Signed: 02/14/2022 10:25:28 AM


Document Has Been Signed on 02/14/2022 10:25 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:REBEKAH SITOMPULFACILITY TYPE:
850
ADDRESS:1200 PLUM TREE ROADTELEPHONE:
(760) 435-0001
CITY:CARLSBADSTATE: CAZIP CODE:
92011
CAPACITY:125CENSUS: 61DATE:
02/14/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Director Rebekah SitompulTIME COMPLETED:
10:30 AM
NARRATIVE
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On 2/14/2022 @ 9:30 a.m., Licensing Program Analyst (LPA), Joelle Redding, made an unannounced visit to follow up on a self-reported incident that occurred on 2/2/2022, wherein a 3 year old child (Child #1) was left alone in the classroom for approximately 18 minutes when the rest of the class transitioned to the playground.

LPA spoke with Director Rebekah Sitompul and Assistant Director, Corrie Barrick. Staff #1 who was supervising the classroom, is no longer working for the company.

Based on the information obtained today, a Type A deficiency will be cited on the accompanying LIC 809D.
LPA, Joelle Redding, informed Director Rebekah Sitompul, that this report, dated 2/14/2022, documents a Type A citation, which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPA, Joelle Redding, informed Director Rebekah Sitompul, to provide a copy of this licensing report, dated 2/14/2022, that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

An exit interview was conducted to include Appeal Rights and Director was provided a copy of the LIC 9224.

SUPERVISOR'S NAME: Renesha PackTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 02/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/14/2022
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 02/14/2022 10:25 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: 02/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/15/2022
Section Cited

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Responsibility for Providing Care an Supervision. The licensee shall provide care and supervision as necessary to meet the children's needs. 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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Based on information obtained though interviews and review of documentation, Child #1 was left behind in the classroom, without supervision, while the class transitioned outdoors, for a period of approximately 18 minutes before being found and comforted by the Assistant Director Corrie Barrick. This is an immediate hazard to children in care.
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Licensing by 2/23/22. Director states that the transition process currently in place involves a face to name to line up at the door, a face to name and count as the children transition thru the door and a final count before they close the door. Staff #1, did not follow that procedure, was immediately placed on leave., and is no longer with the Company.

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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 PackTELEPHONE: (619) 767-2155
LICENSING EVALUATOR NAME: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 02/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/14/2022
LIC809 (FAS) - (06/04)
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