<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600694
Report Date: 11/01/2023
Date Signed: 11/01/2023 12:28:15 PM


Document Has Been Signed on 11/01/2023 12:28 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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108



FACILITY NAME:KINDERCARE - CARLSBAD 1648 - INFANTFACILITY NUMBER:
376600694
ADMINISTRATOR:LEONE POWERFACILITY TYPE:
830
ADDRESS:6270 FLYING LEO CARRILLO LANETELEPHONE:
(760) 431-2558
CITY:CARLSBADSTATE: CAZIP CODE:
92009
CAPACITY:44CENSUS: 36DATE:
11/01/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Director, Leone PowerTIME COMPLETED:
12:40 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 11/1/23, an unannounced case management inspection was conducted by Licensing Program Analysts (LPAs) Saraliz Velando and Gerald Poindexter to follow up on a self-reported incident that occurred on 10/18/23. Upon arrival, LPA met with Director, Leone Power. A tour of the facility was conducted and LPA observed 10 staff and 36 children in care.

The facility self-reported the incident to the department by phone on 10/18/23. During the incident on 10/18/23, staff fed an infant the wrong bottle. According to staff, one of the infants was given a bottle of formula with a different infant’s name and white label and the infant takes breast milk with red label.

Staff members involved were interviewed and based on the information, it appears that the procedure in place was not followed to make sure the infant gets the correct bottle.

Type B Violation was cited. Refer to the next page LIC 809-D for deficiency citation. Facility was provided a copy of the appeal rights.

Exit interview was conducted and report was reviewed with the director, Leone Power.
SUPERVISOR'S NAME: Renesha AskewTELEPHONE: (619) 767-2230
LICENSING EVALUATOR NAME: Saraliz VelandoTELEPHONE: 619-767-2221
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2023
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 11/01/2023 12:28 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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108


FACILITY NAME: KINDERCARE - CARLSBAD 1648 - INFANT
FACILITY NUMBER: 376600694

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/03/2023
Section Cited
CCR
101223(a)(2)

1
2
3
4
5
6
7
Personal Rights - (a)The licensee shall ensure that each child is accorded the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Director states that she will conduct person to person re-training with all the infant teachers and submit proof to the dept. by 11/3/23.
8
9
10
11
12
13
14
Based on staff interviews staff did not use the existing protocol in place to make sure the correct baby bottle was given to the correct infant. This poses a potential risk to the health and safety of children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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) 767-2230
LICENSING EVALUATOR NAME: Saraliz VelandoTELEPHONE: 619-767-2221
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2