376700045-8-16-2023-51-CC-SCLA-CURRJG-20230816130356

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 376700045
Report Date: 08/16/2023
Date Signed: 08/16/2023 01:04:02 PM

Document Has Been Signed on 08/16/2023 01:04 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:	CARLSBAD EDUCATIONAL FOUNDATION-BUENA VISTA ELEM.		FACILITY NUMBER:	376700045
ADMINISTRATOR:	AIMEE SCHMIDT		FACILITY TYPE:	840
ADDRESS:	1330 BUENA VISTA WAY		TELEPHONE:	(760) 331-5426
CITY:	CARLSBAD	STATE: CA	ZIP CODE:	92008
CAPACITY:	140	CENSUS: 0	DATE:	08/16/2023
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME BEGAN:	12:05 PM
MET WITH:	Jennifer Rodriguez		TIME COMPLETED:	01:20 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 08/16/2023 at 12:05pm Licensing Program Analyst (LPA), Samantha Clenista conducted an unannounced case management inspection. Upon arrival, LPA met with Jennifer Rodriguez, Area Manager. Purpose of this visit is to address facility’s request to change rooms. The facility is requesting to be licensed for 140 children (ages TK-12 years old) in the following rooms: Room 10, library, and multipurpose room. Fire clearance was granted on 08/10/2023. Facility is exempt from indoor and outdoor square footage per Title 22, sections 101538.2(c) and 101538.3(c). No measuring of any sort was conducted today. All indoor and outdoor activity space utilized for the children were inspected. There were no children present due to school being out of session. Ms. Rodriguez stated that the school year will start next Wednesday, 08/23/23. LPA inspected all indoor and outdoor play space. Room 10 (main classroom) was equipped with tables and chairs and age-appropriate equipment. Drinking water is readily accessible via water jugs and water cups/water bottles. Snacks are provided and prepared in the classroom. Classroom has storage space for food. The multipurpose room is used for overflow and was not set up yet for children due to the school getting ready for the new school year. LPA advised Ms. Rodriguez to send CCL pictures of the MPR set up prior to usage. Outdoor play areas include: picnic area right of Room 10, middle quad area, blacktop, and grassy area. There are trees used for shade. LPA observed a play structure located near the black top area which had a sticker for ages 5-12 years old. Ms. Rodriguez stated that the children enrolled in this program do not/will not use the playground structure other than the swings and that direct visual supervision will be provided to ensure this. Restrooms designated for children were observed to be separate and allowed for individual privacy. Toilet facilities shall not be utilized simultaneously by children of both sexes. There is a separate staff restroom located across from the main office. There is an operational carbon monoxide detector located above the refrigerator in Room 10. Medications, when present, are stored in a locked cabinet, inaccessible to children.

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Samantha Clenista	TELEPHONE: (619) 818-6740
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2023

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 2

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: CARLSBAD EDUCATIONAL FOUNDATION-BUENA VISTA ELEM.	FACILITY NUMBER: 376700045
	VISIT DATE: 08/16/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Ms. Rodriguez is reminded to keep anything that reads, “Keep Out of Reach of Children” inaccessible to children. First Aid Kit is kept in a cabinet above the teacher’s desk. Isolation area is in a small area behind the teacher’s desk. Isolation bathroom is the staff restroom. Sign-in/out area is located in front of the school. Cleaning supplies and other toxins are inaccessible to children through latches, locks and/or placed on high surfaces. Ms. Rodriguez was reminded that any changes to the facility must be reported to and approved by Community Care Licensing.

Exit interview was conducted and report was reviewed with facility representative, Ms. Rodriguez. A notice of site visit was given to facility representative and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. LPA observed the facility to be in compliance with Title 22 regulation. A school-aged license for 140 children (ages transitional kinder thru 12-years-old) in Room 10, library and multipurpose room is granted and effective today’s date, 08/16/23. Ms. Rodriguez stated she understands that this report shall be kept available at the facility for public review for 3 years.

SUPERVISOR'S NAME: Tashima Daniel	TELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Samantha Clenista	TELEPHONE: (619) 818-6740
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2023

LIC809 (FAS) - (06/04)

Page: 2 of 2