Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600318
Report Date: 03/29/2018
Date Signed 03/29/2018 01:51:13 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 CUYAMACA CENTERFACILITY NUMBER:
376600318
ADMINISTRATOR:MARITZA RENTERIAFACILITY TYPE:
850
ADDRESS:9735 CUYAMACA STREETTELEPHONE:
(619) 562-3423
CITY:SANTEESTATE: CAZIP CODE:
92071
CAPACITY:72CENSUS: 35DATE:
03/29/2018
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Jennifer PhillipsTIME COMPLETED:
02:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Vicky Williamson arrived at the facility to conduct a case management inspection to follow up on incident report. LPA Williamson met with Assistant Director Jennifer Phillips. The following was observed during the inspection: Room #4 (2 - 3 years), 13 children present with 2 qualified teachers, Room #5 (4 - 5 years), 11 children present with 1 qualified teacher, Room #7 (3 - 4 years), 11 children present with 2 qualified teachers.

On March 9, 2018 the director self- reported an incident of possible personal rights violation that allegedly occurred on March 8, 2018. Interviews were conducted with staff members.

On March 8, 2018, Per facility staff, child 1 opened the door to classroom #7, and looked out into the hallway. Staff 1 was in the hallway leaving classroom #6 and witnessed child 1 peering out of the doorway of classroom #7. As Staff 1 walked up to the child, Staff 1 stated that the child grabbed her hand and closed the door of classroom #7. Staff 1 stated that she took the child to the office and notified the Assistant Director immediately. Staff 2 and Staff 3, were in classroom #7 during the time the child peered out of the door and stepped out of the classroom, but were assisting other children in the classroom. Per staff, the duration of the time was approximately 1 minute. LPA conducted interviews with staff. Documents and agency reports were also reviewed. Based on the evidence obtained, it has been determined that facility staff failed to provide adequate care and visual supervision to the children in care resulting in child 1 leaving the classroom unnoticed and without supervision.

Refer to the next page LIC 809D for deficiency citations. Facility was provided a copy of the appeal rights form LIC 9058 and the signature on this form acknowledges receipt of these rights.

The Notice of Site Visit (LIC 9213) was provided to be posted at the facility for 30 days. LPA observed form LIC 9213 posted. An exit interview was conducted.
SUPERVISOR'S NAME: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Vicky WilliamsonTELEPHONE: (619) 767-2214
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2018
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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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 CUYAMACA CENTER
FACILITY NUMBER: 376600318
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/29/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/16/2018
Section Cited
CCR
101229(a)(1)
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Care and Supervision. No child(ren) shall be left without the supervision, including visual observation, of a teacher at any time except as specified in sections 101216.2(e)(1) and 101230(c)(1). On 3/8/18, child 1 walked out of classroom #7, into the hallway were Staff 1 was present. Staff 2 and Staff 3 failed to provide adequate care and
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Assistant Director Jennifer Phillips shall develop and implement a plan to ensure proper care and supervision is met at all times. Director and LPA discussed adding an Aide to classroom and decreasing room size. Director stated that she will meet with all staff to ensure a plan is implemented.
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visual supervision to the children in care resulting in child 1 leaving the classroom unnoticed and without supervision. This poses a potential health and safety risk to the children in care.
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A copy of the plan, agenda and sign in sheets for meeting is to be submitted to Department as proof of correction by Monday, April 16, 2018.
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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: Tulam VuTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Vicky WilliamsonTELEPHONE: (619) 767-2214
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2018
LIC809 (FAS) - (06/04)
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