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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701342
Report Date: 08/02/2023
Date Signed: 11/09/2023 03:12:49 PM


Document Has Been Signed on 11/09/2023 03:12 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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108



FACILITY NAME:DEL MAR HIGHLANDS KINDERCARE PRESCHOOLFACILITY NUMBER:
376701342
ADMINISTRATOR:KRISTINA SIMONFACILITY TYPE:
850
ADDRESS:3808 TOWNSGATE DRIVETELEPHONE:
(858) 794-7710
CITY:SAN DIEGOSTATE: CAZIP CODE:
92130
CAPACITY:68CENSUS: 13DATE:
08/02/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Director, Kristina SimonTIME COMPLETED:
05:30 PM
NARRATIVE
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On 8/2/22 at 2:20pm, an unannounced case management inspection was conducted by Licensing Program Analyst (LPA) Saraliz Velando to follow up on an incident report that occurred on 7/3/23 at approximately 4:08pm. Upon arrival, LPA met with Director, Kristina Simon and Assistant Director, Johanna Herrera. A tour of the facility was conducted, and LPA observed 13 preschool children in care and 7 staff.

The facility self-reported the incident to the department on 7/5/23. During the incident a preschool child was found crying in the bathroom of their classroom by a teacher from a different classroom and reunited back with his class. According to staff, the child was missing for approximately 3-5 minutes.

The Assistant Director and two staff members were interviewed and based on the information, it appears that the Face-to-Name procedure was not followed properly during the incident, resulting in failure to visually supervise.

Type B Violation was cited.

Refer to the next page LIC 809-D for deficiency citation. Facility was provided a copy of the appeal rights.

Exit interview was conducted and report was reviewed with Director, Kristina Simon.

A notice of site visit was given and observed posted, this notice shall remain posted for 30 days.
SUPERVISOR'S NAME: Renesha AskewTELEPHONE: (619) 767-2230
LICENSING EVALUATOR NAME: Saraliz VelandoTELEPHONE: 619-767-2221
LICENSING EVALUATOR SIGNATURE:
DATE: 08/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/14/2023
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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Document Has Been Signed on 11/09/2023 03:12 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108


FACILITY NAME: DEL MAR HIGHLANDS KINDERCARE PRESCHOOL
FACILITY NUMBER: 376701342

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/18/2023
Section Cited
CCR
101229(a)(1)

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RESPONSIBILITY FOR PROVIDING CARE AND SUPERVISION
(1) No child(ren) shall be left without the supervision... Supervision shall include visual observation.
This requirement was not met as evidenced by:
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 Director stated she will have a CSR training on transitioning by 8/18/23 and submit proof and sign in sheet to the dept.
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Based on staff interviews the facility failed to provide visual supervision resulting in a child was left alone in the classroom.
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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: Renesha AskewTELEPHONE: (619) 767-2230
LICENSING EVALUATOR NAME: Saraliz VelandoTELEPHONE: 619-767-2221
LICENSING EVALUATOR SIGNATURE:
DATE: 08/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/14/2023
LIC809 (FAS) - (06/04)
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