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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700078
Report Date: 10/14/2021
Date Signed: 10/14/2021 04:30:29 PM

Document Has Been Signed on 10/14/2021 04:30 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
CCLD Regional Office, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:CARLSBAD EDUCATIONAL FOUNDATION-PACIFIC RIM ELEM.FACILITY NUMBER:
376700078
ADMINISTRATOR:RACHEL TAMAYOFACILITY TYPE:
840
ADDRESS:1100 CAMINO DE LAS ONDASTELEPHONE:
(760) 602-8489
CITY:CARLSBADSTATE: CAZIP CODE:
92009
CAPACITY: 140TOTAL ENROLLED CHILDREN: 100CENSUS: 62DATE:
10/14/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:38 PM
MET WITH:Ruby Solis, Site DirectorTIME COMPLETED:
04:40 PM
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On October 14, 2021 at 2:38 p.m. Licensing Program Analyst (LPA) Leilani Curtis conducted an unannounced Plan of Correction inspection to verify that the citation issued on LPA Curtis’s Annual Inspection dated 9/30/21 has been addressed. LPA met with site director Ruby Solis and toured the facility. There were 62 children and 5 staff members present outside in the lunch area. Appropriate ratio/capacity were observed. Staff members have the required background clearances and are associated to the facility.

On 9/30/21 the facility did not have child admission agreement forms available for review. During today’s inspection LPA reviewed admission agreement forms electronically for the 10 children (C1-C10) whose files were reviewed on 9/30/21. The facility is in compliance. No deficiencies are cited.

An exit interview was conducted with the site director and appeal rights (LIC 9058 1/16) were discussed. The site director’s signature on this form acknowledges receipt of these rights. LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS. LPA observed the Ms. Solis post notice of site visit.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Grace Curtis
LICENSING EVALUATOR SIGNATURE: DATE: 10/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/14/2021
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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