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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600696
Report Date: 11/18/2020
Date Signed: 11/18/2020 03:00:00 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: 70DATE:
11/18/2020
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Leone PowerTIME COMPLETED:
11:09 AM
NARRATIVE
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Covid-19 State of Emergency

On November 18, 2020 at 10:30 a.m. Licensing Program Analyst, Leilani Curtis, conducted an unannounced inspection via Zoom to follow up on a self reported incident that occurred on 11/13/20 wherein a 5 year old child (child #1) was found exiting a classroom alone, unsupervised. LPA met with Director Leone Power and proceeded to tour the facility. There were 70 children with 8 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 and Staff #3. On 11/13/20 at approximately 4:25 p.m. a child was left unsupervised for approximately 10 to 15 seconds in a classroom. Staff #1 was standing in the classroom doorway when the child went into the restroom located in the classroom. Staff #1 left the classroom and returned to the playground without realizing the child was still in the restroom. Staff #2 and Staff #3 both state that while standing in the hallway next to the classroom they observed the child in the classroom unattended. The child opened the classroom door and walked outside to rejoin his class. Staff #3 walked outside behind the child to ensure that he reached his teacher and the class on the playground. Based on the interviews conducted it was determined that Child #1 was unsupervised in the classroom.

See LIC809D for cited deficiency. A civil penalty of $250.00 has been assessed. An exit interview was conducted and appeal rights (LIC 9058 1/16) were discussed. A copy of this report as well as a copy of the appeal rights were emailed to the Director at the conclusion of the inspection. Licensee will confirm receipt of this report via e-mail and the reply of confirmation will serve as the signature acknowledging these rights. LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISOR'S NAME: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace CurtisTELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2020
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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
FACILITY NUMBER: 376600696
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/18/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/11/2020
Section Cited

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101229(a)(1) Responsibility for Providing Care and Supervision:(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time...This requirement was not met as evidenced by:
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Based on interviews conducted with Staff #1, Staff #2 and Staff #3, staff members did not maintain supervision of children at all times. On 11/13/20 a child was found alone, unsupervised exiting a classroom after using the class restroom by Staff #2 and Staff #3. This poses a potential health and safety risk to children in care.
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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: Tashima DanielTELEPHONE: (619) 767-2242
LICENSING EVALUATOR NAME: Grace CurtisTELEPHONE: (619) 767-2235
LICENSING EVALUATOR SIGNATURE:
DATE: 11/18/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/18/2020
LIC809 (FAS) - (06/04)
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