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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600788
Report Date: 01/14/2021
Date Signed: 01/14/2021 10:45:24 AM

Document Has Been Signed on 01/14/2021 10:45 AM - 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:KINDERCARE LEARNING CENTER - PASEO LADERAFACILITY NUMBER:
376600788
ADMINISTRATOR:ANA KINGFACILITY TYPE:
850
ADDRESS:1101 PASEO LADERATELEPHONE:
(619) 482-1800
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY: 78TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
01/14/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Facility Director Ana KingTIME COMPLETED:
09:15 AM
NARRATIVE
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On 01/14/2021, at 09:00AM, LPA Luigi Gargaro, conducted an unannounced case management to the facility. The visit was conducted as a tele-visit due to the Covid-19 outbreak. The basis for the visit was for the issuance of a citation when it was determined that the facility did not report an injury to a child in care that was discovered by a staff member and required the child in question to seek medical attention.

The San Diego Child Care Regional Office did not have a record of receiving either a verbal or written report of the 09/25/20 incident and the facility was unable to provide evidence that either type of notification was submitted to the agency. The facility was issued a type B violation for the deficiency today.

Analyst reviewed the report with the facility director, Ana King, and advised her that a copy of it, the facility's corresponding appeal rights and notice of site visit will be e-mailed to her and that acknowledgement of the receipt of the report is to be received within twenty four hours.
Jason Garay
Luigi Gargaro
DATE: 01/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/14/2021
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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Document Has Been Signed on 01/14/2021 10:45 AM - It Cannot Be Edited


Created By: Luigi Gargaro On 01/14/2021 at 08:42 AM
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: KINDERCARE LEARNING CENTER - PASEO LADERA
FACILITY NUMBER: 376600788

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/14/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/19/2021
Section Cited

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Reporting Requirements. Upon the occurrence,...of any of the events specified in (d)(1) below, a report shall be made to the Department...within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event.This requirement was not met as evidenced by: based on interviews and record reviews,
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facility failed to submit a written or verbal unusual incident report to the Department after child #1 was discovered by staff to have sustained an injury that required medical treatment. Not meeting Licensing reporting requirements is a potential danger to children 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:Jason Garay
LICENSING EVALUATOR NAME:Luigi Gargaro
LICENSING EVALUATOR SIGNATURE:
DATE: 01/14/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/14/2021


LIC809 (FAS) - (06/04)
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