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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600694
Report Date: 10/18/2019
Date Signed: 10/18/2019 10:38:27 AM

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: DATE:
10/18/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:29 AM
MET WITH:Director Leone PowerTIME COMPLETED:
10:45 AM
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Licensing Program Analyst, Joelle Redding, made an unannounced visit to complete evaluation of 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.

During today's visit, LPA interviewed the Director and Staff #2, 3, and 4 in relation to the incident.

According to accounts, the dislocation most likely happened during the course of normal play, through no intentional fault of staff. Staff has been retrained on how to hold and play with children to avoid a recurrence of the incident. Ratios were met, supervision was in place, staff responded appropriately and the facility reported timely.

No deficiencies are cited.

NOTICE OF SITE VISIT WAS POSTED AND WILL REMAIN POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2019
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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