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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600344
Report Date: 05/06/2025
Date Signed: 05/06/2025 03:30:15 PM

Document Has Been Signed on 05/06/2025 03:30 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:KINDERCARE PASEO MONTRIL INFANTFACILITY NUMBER:
376600344
ADMINISTRATOR/
DIRECTOR:		ALMA GANDARILLAFACILITY TYPE:
830
ADDRESS:10065 PASEO MONTRILTELEPHONE:
(858) 484-3232
CITY:SAN DIEGOSTATE: CAZIP CODE:
92129
CAPACITY: 36TOTAL ENROLLED CHILDREN: 36CENSUS: DATE:
05/06/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Alma GandarillaTIME VISIT/
INSPECTION COMPLETED:
03:50 PM
NARRATIVE
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On 05/06/2025 @ 1:00PM Licensing Program Analyst (LPA) Mahjoba Mohsini conducted an unannounced case management inspection in reference to a self reported incident that occurred on 04/22/2025 wherein an infant was given the wrong bottle. LPA toured the infant classroom with (Houda Ahmadi), Assistant Director. LPA inspected the infant’s classroom, the classroom refrigerator and observed all (bottles were labeled, With today’s date, Children’s Names), took a classroom census and present were (7) infants and 3 staff. Appropriate ratios were observed. Facility estimated that the child ingested about (5 oz) of milk. Both parents were immediately notified of the incident. It is being noted that the child did not suffer from any adverse effect after ingesting wrong milk. Three staff were interviewed and of the three staff, S#1 was present at the time of the incident. Staff #1 stated that at approximately 1:00PM, she began bottle warming process for 3 children when a newly enrolled Child (C#1) started to cry. Then, Staff #1 wanted to give C#1 attention and ultimately, giving C#1 bottle belonging to C#2. At 2:00PM, Staff #1 realized she had given wrong bottle after Staff #2 inquired about missing bottle for C#2. Upon realization, Staff #1 immediately reported the incident to Director’s Assistant who began to investigate the incident then proceeded to notify parents of C#1, C#2 and center Director. Child did not suffer from any negative reactions. There was another Staff #3 present during the incident helping with feeding another child (C#3) and did not notice the incident.

Preventative measures were implemented to ensure this type of incident does not recurs, the center has taken the following corrective actions: Effective immediately the center has implemented a bottle feeding log that requires dual verification. Staff members must initial each feeding entry to confirm the correct bottle was used for the correct child, retraining of staff, the entire center were retrained on bottle labeling verification procedures and daily feeding protocols, daily random check to ensure that feeding logs are accurate and consistently completed.

NAME OF LICENSING PROGRAM MANAGER: Joelle Redding
NAME OF LICENSING PROGRAM ANALYST: Mahjoba Mohsini
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 05/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/06/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 05/06/2025 03:30 PM - It Cannot Be Edited


Created By: Mahjoba Mohsini On 05/06/2025 at 02:54 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: KINDERCARE PASEO MONTRIL INFANT
FACILITY NUMBER: 376600344

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/06/2025
Section Cited
CCR
101223(a)(2)

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PERSONAL RIGHTS
To be accorded with safe, healthful and compfortable accomodaions...

This was not met as evidenced by:
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DEFICIENCY WAS CORRECTED IMMEDIATLEY. Director conducted a meeting with all the infant and toddler on 4/24/2025. Director provided meeting agenda and minute log and attendees.
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BAsed on the unusual incident report and direcot's account ot the incident, an infant was given the woring bottle.
Infant did not surrfer from any adverse effects after ingesting wrong formul/milk.
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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.
Joelle Redding
NAME OF LICENSING PROGRAM MANAGER:
Mahjoba Mohsini
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 05/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/06/2025


LIC809 (FAS) - (06/04)
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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: KINDERCARE PASEO MONTRIL INFANT
FACILITY NUMBER: 376600344
VISIT DATE: 05/06/2025
NARRATIVE
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Type B deficiency was cited today. Type B deficiency if not corrected poses a potential risk to the health, safety or personal rights of clients in care. LPA was provided proof of corrections.

Exit interview was conducted with Ms. Houda Ahmadi. LPA reviewed and provided Ms. Houda a copy of this report. Appeal rights and Notice of Site visit were also given. Notice of site visit shall be posted for 30 days.

NAME OF LICENSING PROGRAM MANAGER: Joelle Redding
NAME OF LICENSING PROGRAM ANALYST: Mahjoba Mohsini
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2025
LIC809 (FAS) - (06/04)
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