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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 421701053
Report Date: 02/13/2024
Date Signed: 02/13/2024 12:26:59 PM


Document Has Been Signed on 02/13/2024 12:26 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
SANTA BARBARA CC RO, 6500 HOLLISTER AVE., SUITE 200
GOLETA, CA 93117



FACILITY NAME:CARPINTERIA KINDERKIRK PRESCHOOL & DAY CARE CENTEFACILITY NUMBER:
421701053
ADMINISTRATOR:KALEIGH WILLIAMSFACILITY TYPE:
850
ADDRESS:1111 VALLECITO RDTELEPHONE:
(805) 684-4070
CITY:CARPINTERIASTATE: CAZIP CODE:
93013
CAPACITY:104CENSUS: 30DATE:
02/13/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:01 AM
MET WITH:Ana CardonaTIME COMPLETED:
12:35 PM
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On February 13, 2024 Licensing Program Analysts (LPAs) Susana Martinez and Aaliyah Zendejas conducted an unannounced Case Management - Incident inspection. LPAs met with assistant director Ana Cardona and advised of the purpose of the inspection. LPA's were provided with a tour of the facility inside and outside. There were 30 children in care of 5 staff members at the time of the inspection. No bodies of water were observed at the time of inspection.

On 11/09/2023, assistant director Ana Cardona contacted Community Care Licensing (CCL) to self-report an incident of a child (C1) was climbing a tree with three other children. The other children ran away from C1 and called for C1. Then C1 jumped from the tree and right leg bent underneath C1 and left leg went out in front. Center provided first aid to child and child was picked up by parents and taken to seek medical attention.

LPA Martinez interviewed assistant director to obtain more information. Ana states C1 was within her peripheral vision as she was standing within two feet of the child. Interviews determined that C1 broke their tibia and was out of day-care for about a week. C1 returned to day-care with no restrictions. C1 is still enrolled in day-care.

LPA determined that the incident was true and did occur. The incident was determined risk in play. The Given the facility's account of the incident when reporting it to CCL and how they addressed the incident, LPA deemed the facility's action was appropriate.



No deficiencies were issued during today's inspection.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with assistant director Ana Cordova.

SUPERVISOR'S NAME: Ana TolentinoTELEPHONE: (805) 562-0437
LICENSING EVALUATOR NAME: Susana MartinezTELEPHONE: 805-689-4212
LICENSING EVALUATOR SIGNATURE:
DATE: 02/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2024
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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