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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372000455
Report Date: 02/15/2023
Date Signed: 02/15/2023 10:53:10 AM

Document Has Been Signed on 02/15/2023 10:53 AM - It Cannot Be Edited

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:PILGRIM DAY CARE CENTERFACILITY NUMBER:
372000455
ADMINISTRATOR:J. GOINS & C. O'CONNORFACILITY TYPE:
850
ADDRESS:2020 CHESTNUT AVENUETELEPHONE:
(760) 729-4464
CITY:CARLSBADSTATE: CAZIP CODE:
92008
CAPACITY: 110TOTAL ENROLLED CHILDREN: 110CENSUS: 0DATE:
02/15/2023
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Jennifer Goins and Colleen O'ConnorTIME COMPLETED:
11:00 AM
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On 02/15/23 at 10:30am, Licensing Program Analyst (LPA), Samantha Clenista and Licensing Program Manager (LPM), Monica Cuddy conducted an announced virtual office meeting (via Zoom) to discuss the facility's recent history of issued citations and serious incidents that have occurred within the past three years. Meeting was conducted with facility's Co-Director's, Jennifer Goins and Colleen O'Connor.

Over the period of three years (2020-present day), the facility has had a total of 4 complaints and 4 incidents where a child sustained a serious injury. All incidents were observed by staff and after investigation, LPA confirmed that appropriate ratio was provided and that the equipment relating to the incidents were age appropriate and free of hazards. Citations that were issued throughout the three years resulting from either a complaint and/or incident, were 2 Type B's citations for staff failing to notify day care child's parent of injury and one Type A citation for staff failing to seek medical attention to day care child. It is noted that the facility corrected all deficiencies in a timely manner. Facility has conducted several staff training's to ensure children are appropriately supervised and that they understand the protocol of first aide and reporting requirements.

LPM discussed with Facility Representatives the seriousness of the above deficiencies and incidents. Facility representatives were provided with the following resources: A Technical Support Program (TSP) brochure, for questions related to the TSP, email: childcaretechnicalsupport@dss.ca.gov, active supervision handout, ccld.childcarevideos.org, Advocate information was provided: (714)-703-2800 or childcareadvocatesprogram@dss.ca.gov, sdincidentreports@dss.ca.gov and the Duty Line (619)-767-2248.

Facility Representatives were informed that repeated violations or failure to comply with licensing laws and regulations may result in administrative action taken by the Department. Facility Representatives, Jennifer Goins and Colleen O'Connor stated they understood and will ensure the facility complies with all regulations and laws governing Child Care Centers. A copy of this report was provided at conclusion of meeting via email. A response to the email within 24 hours confirming receipt from either Jennifer Goins or Colleen O'Connor will constitute as their signature below.

SUPERVISORS NAME: Monica Cuddy
LICENSING EVALUATOR NAME: Samantha Clenista
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2023
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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