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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 372005101
Report Date: 08/22/2025
Date Signed: 09/10/2025 11:15:53 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO N. CC RO, 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
08/15/2025 and conducted by Evaluator Mahjoba Mohsini
COMPLAINT CONTROL NUMBER: 51-CC-20250815113143
FACILITY NAME:CARMEL MOUNTAIN PRESCHOOLFACILITY NUMBER:
372005101
ADMINISTRATOR:DONNA TACONIFACILITY TYPE:
850
ADDRESS:9510 CARMEL MOUNTAIN ROADTELEPHONE:
(858) 484-4877
CITY:SAN DIEGOSTATE: CAZIP CODE:
92129
CAPACITY:249CENSUS: 135DATE:
08/22/2025
UNANNOUNCEDTIME BEGAN:
09:31 AM
MET WITH:Karina BarrettTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Facility staff did not follow reporting requirements
INVESTIGATION FINDINGS:
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THIS IS AN AMENDED VERSION OF THE ORIGINAL REPORT.
On 8/22/2025 9:31 a.m. LPAs Mahjoba Mohsini and Nancy Diaz conducted an unannounced visit to investigate a complaint received on 8/19/25 regarding the above allegation. LPAs met with facility representatives Carol Fugleberg (resource manager) and Karina Barrett (director's assistant). LPAs toured the facility and observed 135 children with 37 staff. Facility is within capacity and ratio.

LPAs interviewed staff, obtained documents and reviewed records. Based on the information obtained, there were unusual incidents between children that occurred in February and again in April, which the facility failed to report to Licensing as required. The allegation is valid because the preponderance of evidence has been met. Therefore, the allegation is substantiated. A Type B deficiency is cited on the accompanying LIC 9099D.
Exit interview was conducted, report was reviewed, and a copy of the report was provided to the facility representatives.


Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Keturah Lane
LICENSING EVALUATOR NAME: Mahjoba Mohsini
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2025
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 3
Control Number 51-CC-20250815113143
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: CARMEL MOUNTAIN PRESCHOOL
FACILITY NUMBER: 372005101
VISIT DATE: 08/22/2025
NARRATIVE
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INTENTIONALLY LEFT BLANK
SUPERVISORS NAME: Keturah Lane
LICENSING EVALUATOR NAME: Mahjoba Mohsini
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 51-CC-20250815113143
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: CARMEL MOUNTAIN PRESCHOOL
FACILITY NUMBER: 372005101
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/22/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/29/2025
Section Cited
CCR
101212
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Reporting Requirements

(a) Each licensee or applicant shall furnish to the Department reports as required by the Department including, but not limited to, the following...
The requirement was not met as observed:
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 Director's assistant Karina Barrett states she will complete component 3 orientation trainings through child care licensing to review reporting requirements and will submit proof to LPA by 8/29/2025
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Based on interviews with staff, unusual incident was not reported to child care licensing department.
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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.
SUPERVISORS NAME: Keturah Lane
LICENSING EVALUATOR NAME: Mahjoba Mohsini
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3