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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 376700079
Report Date: 07/05/2022
Date Signed: 07/06/2022 11:11:31 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/29/2022 and conducted by Evaluator Samantha Clenista
PUBLIC
COMPLAINT CONTROL NUMBER: 51-CC-20220429165719
FACILITY NAME:CARLSBAD EDUCATIONAL FOUNDATION - KELLY ELEMENTARYFACILITY NUMBER:
376700079
ADMINISTRATOR:IZABELLA ROMOFACILITY TYPE:
840
ADDRESS:4885 KELLY DRIVETELEPHONE:
(760) 331-5865
CITY:CARLSBADSTATE: CAZIP CODE:
92008
CAPACITY:90CENSUS: 0DATE:
07/05/2022
ANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:April SmithTIME COMPLETED:
10:10 AM
ALLEGATION(S):
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Facility is operating out of ratio.
INVESTIGATION FINDINGS:
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On 07/05/2022 at 9:40am, Licensing Program Analyst (LPA) Samantha Clenista completed an unannounced inspection for the purpose of delivering the finding for the above allegation. LPA met with April Smith, Area Manager, outside Elementary. There were no children present during inspection due to the program being closed for summer break. During the course of the investigation, LPA conducted interviews with several staff and day care parents. Based upon information gathered through interviews, the preponderance of evidence standard has been met. There is enough supporting information to prove that the facility has operated out of ratio and that the above allegation is to be substantiated. An exit interview was conducted with Ms. Smith. Due to printer malfunctions, LPA will email a copy of this report, appeal rights, a Notice of Site Visit to Ms. Smith. See 9099D for cited deficiency.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Samantha ClenistaTELEPHONE: (619) 818-6740
LICENSING EVALUATOR SIGNATURE:

DATE: 07/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 51-CC-20220429165719
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: CARLSBAD EDUCATIONAL FOUNDATION - KELLY ELEMENTARY
FACILITY NUMBER: 376700079
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/05/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/08/2022
Section Cited
CCR
101516.5(b)(1)
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Teacher-Child Ratio. A teacher shall supervise no more than 14 children or with an aide a maximum of 28 children. This requirement was not met as evidenced by;
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Ms. Smith explained that ever since the last incident of the facility operating out of ratio (estimated a couple months ago), the facility has hired more staff and has changed hours of staffing to accommodate the currently enrolled number of children.
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based on information obtained from witness interviews, it is determined that the facility has operated out of ratio (specific date unknown). This poses a Potential Health and Safety risk to the clients in care.
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In addition, Ms. Smith stated she will provide LPA with an updated LIC500 by POC due date showing that the facility has enough staffing during hours of operation, including floaters. Ms. Smith stated that ever since the changes have been made, no further out of ratio incidents have occurred.
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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: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Samantha ClenistaTELEPHONE: (619) 818-6740
LICENSING EVALUATOR SIGNATURE:

DATE: 07/05/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2