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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600696
Report Date: 06/09/2021
Date Signed: 06/09/2021 12:50:15 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 1648FACILITY NUMBER:
376600696
ADMINISTRATOR:LEONE POWERFACILITY TYPE:
850
ADDRESS:6270 FLYING LEO CARRILLO LANETELEPHONE:
(760) 431-2558
CITY:CARLSBADSTATE: CAZIP CODE:
92009
CAPACITY:97CENSUS: 73DATE:
06/09/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Leone PowerTIME COMPLETED:
01:00 PM
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On June 9, 2021 at 11:05 a.m. Licensing Program Analyst, Leilani Curtis, conducted an unannounced inspection to follow up on a self-reported incident that occurred on 5/18/21 wherein a 3 year old child (Child #1) walked up the stairs of the play structure, slipped, fell and cut his chin. LPA met with Director Leone Power and proceeded to tour the facility. There were 73 children with 9 staff members present. Appropriate ratio/capacity were observed. Staff members have the required background clearances and are associated to the facility.

LPA interviewed Staff #1, Staff #2, Child #1, Director (D1) and Asst. Director (D2). On 5/18/21 at approximately 4:30 p.m. child #1 was walking up the stairs of the play structure when he slipped and fell. He hit his chin on the side of the stairs resulting in a cut on his chin. The play structure is made of plastic and is age appropriate. At the time of the incident there were 16 children and two staff members present on the playground. Proper ratio and supervision were in place. As soon as the incident occurred the child’s injury was cleaned, and his mother was notified. The child went to the doctor and received approximately three stitches on his chin. The child returned to the facility on 5/19/21 and remains in care. The director states that summer safety training was held with the staff and children were reminded on proper play equipment usage. The facility responded appropriately and reported timely.

No deficiencies are cited.

An exit interview was conducted with the director and appeal rights (LIC 9058 1/16) were discussed. The director’s signature on this form acknowledges receipt of these rights. LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS. LPA observed the director post notice of site visit.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace CurtisTELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:

DATE: 06/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/09/2021
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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