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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600650
Report Date: 06/25/2019
Date Signed: 06/25/2019 04:30:42 PM

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:KINDERCARE-CARLSBADFACILITY NUMBER:
376600650
ADMINISTRATOR:REBEKAH SITOMPULFACILITY TYPE:
850
ADDRESS:1200 PLUM TREE ROADTELEPHONE:
(760) 435-0001
CITY:CARLSBADSTATE: CAZIP CODE:
92011
CAPACITY:125CENSUS: 30DATE:
06/25/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Director Rebekah SitompulTIME COMPLETED:
04:40 PM
NARRATIVE
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Licensing Program Analyst, Joelle Redding, made an unannounced visit to follow up on a self reported incident that occurred on 6/13/19, wherein a 3 year old child (Child #1), left the playground and exited the front door, unsupervised by staff.

LPA spoke with Staff #1 who was on the playground with 13 children (including Child #1) along with Staff #2. Staff #1 stated that he was checking children out as it was pick up time. Staff #2, who had been standing near the door to the classroom, called to him that Child #1 had just left the playground and gone into the empty classroom. Staff #1 stated that they were in ratio so he told her to follow Child #1 inside to verify that his father had picked him up. Staff #1 stated that Child #1's father had been talking to Child #1 through the gate just before. Shortly after Staff #2 followed Child #1 into the classroom, she returned telling Staff #1 that Child #1 had gone with his father. Staff #2 did not know until later that Child #1 was not with his father and had gone all the way through the lobby to the front sidewalk where his dad intercepted him. LPA read the statement of Staff #3 who had been present in the lobby when Child #1 had walked into it. The statement states that Child #1 told her that he was with daddy.

Since the incident, the facility no longer employs Staff #2 and has instituted a policy that the doors are locked from the playground to the classrooms. This will ensure that a child cannot leave without staff knowledge and/or until a parent is present for pick up. Staff did not verify that Child #1 was with his parent after he exited the playground. This created an immediately hazardous situation as the child exited the facility where there was access to the parking lot, without appropriate supervision.

A Type A deficiency will be cited on the accompanying LIC 809D. Appeal Rights (1/16) were discussed and provided.

See Page 2 for AB 633 procedures.
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: KINDERCARE-CARLSBAD
FACILITY NUMBER: 376600650
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/25/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/26/2019
Section Cited

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Responsibility for Providing Care and Supervision. No child(ren) shall be left without the supervision of a teacher at any time...Supervision shall include visual observation. This requirement was not met when Child #1 exited the playground and Staff #2 did not verify that the child was with his parent before she returned to the playground.
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and Staff #3 did not verify that Child #1 was with his parent before leaving the lobby to the parking lot. This determination was based upon interviews with the Director and Staff #1 and Staff #3's statement. This is an immediate hazard to children in care.
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A summary of content and a roster of teachers trained will be submitted by 7/9/19.

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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: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 06/25/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/25/2019
LIC809 (FAS) - (06/04)
Page: 3 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME: KINDERCARE-CARLSBAD
FACILITY NUMBER: 376600650
VISIT DATE: 06/25/2019
NARRATIVE
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Note: Per Assembly Bill 633 (Parent Notification Requirements) the facility is to provide a copy of this Licensing Report to the parents of all children currently enrolled as well as any children newly enrolled over the next 12 month period. Parents are to sign form LIC 9224, Acknowledgment of Receipt of Licensing Reports and the form is to be kept in each child's file for Licensing's review. In addition, this Licensing report is to be posted along with the Notice of Site Visit for 30 days.

LIC 9224 was provided during this visit.

SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2019
LIC809 (FAS) - (06/04)
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