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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600694
Report Date: 10/15/2019
Date Signed: 10/15/2019 02:11:43 PM

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-CARLSBAD 1648-INFANTFACILITY NUMBER:
376600694
ADMINISTRATOR:LEONE POWERFACILITY TYPE:
830
ADDRESS:6270 FLYING L.C. LANETELEPHONE:
(760) 431-2558
CITY:CARLSBADSTATE: CAZIP CODE:
92009
CAPACITY:34CENSUS: 20DATE:
10/15/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Program Specialist Alicia AbelTIME COMPLETED:
02:15 PM
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Licensing Program Analyst, Joelle Redding, made an unannounced visit to follow up on a self-reported incident that occurred on 9/23/19 wherein a 1 1/2 year old child (Child #1) sustained a dislocated elbow in the classroom.

LPA interviewed Staff #1. She stated that she was in the infant room with Staff #2. Both of them were giving the regular teachers their breaks. There were approximately 5 children present. Staff #1 stated she was play tickling Child #1 and Child #1 raised her hands to her. Staff #1 stated that she took Child #1's hands and lifted her slightly up then put her hands under her arms and lifted her in a little toss. That's when she started to cry. Staff #1 thought it was her shoulder but was later told that it was a dislocated elbow. Staff #2 and the Director were absent today. LPA will follow up with them at a later date.

No deficiencies are cited.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2019
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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