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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700079
Report Date: 11/05/2024
Date Signed: 11/05/2024 03:00:58 PM

Document Has Been Signed on 11/05/2024 03:00 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 - KELLY ELEMENTARYFACILITY NUMBER:
376700079
ADMINISTRATOR/
DIRECTOR:		IZABELLA ROMOFACILITY TYPE:
840
ADDRESS:4885 KELLY DRIVETELEPHONE:
(760) 331-5865
CITY:CARLSBADSTATE: CAZIP CODE:
92008
CAPACITY: 140TOTAL ENROLLED CHILDREN: 124CENSUS: 32DATE:
11/05/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Area Manager, April SmithTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
NARRATIVE
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LPAs (Licensing Program Analysts) Saraliz Velando and Adriana Macias conducted an unannounced follow up on a self-reported incident that occurred on 9/26/24. On 9/26/24, a child was called because the parents were there to pick up and two students that share the same name, retrieved their belongings and walked out to the designated pick-up area, but it was not C1's parents. Staff did not notice that C1 exited the school gate and was found outside of the facility without adult supervision by a parent.

LPA conducted staff interviews and determined that the child was without staff supervision for approximately 3 minutes. For this incident, a Type B deficiency will be issued today. There were 32 children with 5 staff present. An exit interview was conducted with the Area Manager, April Smith. The Appeal Rights with a copy of the report was provided. The notice of site visit was posted and must remain for 30 days.
SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Saraliz Velando
LICENSING EVALUATOR SIGNATURE: DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2024
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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Document Has Been Signed on 11/05/2024 03:00 PM - It Cannot Be Edited


Created By: Saraliz Velando On 11/05/2024 at 02:30 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: CARLSBAD EDUCATIONAL FOUNDATION - KELLY ELEMENTARY
FACILITY NUMBER: 376700079

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/15/2024
Section Cited
CCR
101229(a)

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101229(a) Responsibility for Providing Care and Supervision- The licensee shall provide care and supervision as necessary to meet the child’s needs. This requirement was not met as evidenced by…
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Site Coordinator stated that he will have a staff training on supervision and submit proof of attendance to the Dept by 11/15/24.
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Based on staff interviews the licensee did not comply with the section cited above in that a child was left unsupervised for approximately 3 minutes which posed a potential health, safety or personal rights risk to persons in care.
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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:Joelle Redding
LICENSING EVALUATOR NAME:Saraliz Velando
LICENSING EVALUATOR SIGNATURE:
DATE: 11/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/05/2024


LIC809 (FAS) - (06/04)
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