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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600696
Report Date: 05/24/2024
Date Signed: 05/24/2024 02:12:17 PM


Document Has Been Signed on 05/24/2024 02:12 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 - CARLSBAD 1648FACILITY NUMBER:
376600696
ADMINISTRATOR:LEONE PAULFACILITY TYPE:
850
ADDRESS:6270 FLYING LEO CARRILLO LANETELEPHONE:
(760) 431-2558
CITY:CARLSBADSTATE: CAZIP CODE:
92009
CAPACITY:80CENSUS: 53DATE:
05/24/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Lorena Rizaga, Program SpecialistTIME COMPLETED:
02:20 PM
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On 5/24/24 at 1:00pm, Licensing Program Analyst (LPA) Patrick Ma, visited the facility to conduct a case management site inspection. Upon arrival, LPA met with Program Specialist, Lorena Arizaga. Director had left for the day. The purpose of this visit is to follow up on a self reported incident that occurred on 4/15/24 where Child C1 sustained an injury on the playground.

LPA conducted staff interviews, inspected the playground, made a confidential names list, and reviewed related documents. LPA observed cushion padding under playground structure was present but advised to replace as best practice.

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: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2024
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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