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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600696
Report Date: 03/08/2021
Date Signed: 03/08/2021 12:16:14 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: 68DATE:
03/08/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Leone PowerTIME COMPLETED:
12:20 PM
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Covid-19 State of Emergency
On March 8, 2021 at 11:15 a.m. Licensing Program Analyst, Leilani Curtis, conducted an unannounced inspection via Zoom to follow up on a self reported incident that occurred on 3/3/21 wherein a 3 year old child (child #1) who was playing in the “home living area” of the classroom tripped, fell and cut the corner of her eye on a table. LPA met with Director Leone Power and proceeded to tour the facility. There were 68 children with 7 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, Child#1 and the Director. On 3/3/21 at approximately 4:40 p.m. child #1 was walking through the "home living area" to put away some books. As she walked through the area she slipped, fell and hit the corner of a table resulting in a cut near her left eye. The area where the incident occurred consists of a table on top of a rug, a mirror attached to one wall and a play kitchen. At the time of the incident there were 15 children and two staff members present. Proper ratio and supervision were in place. As soon as the incident occurred Staff #1 tended to the wound and applied ice. The Asst Director called the child's parents and the child was promptly picked up by her father. The child went to the doctor and received one stitch near the left eye. The child returned to the facility today, 3/8/21. The facility responded appropriately and reported timely. The Director and Staff #1 state that as a precaution the table has been removed from the area.

No deficiencies are cited.

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. The Director 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: 03/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2021
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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