Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700083
Report Date: 10/08/2015
Date Signed: 10/08/2015 05:44:58 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:CARLSBAD EDUCATIONAL FOUNDATION-AVIARA OAKS ELEM.FACILITY NUMBER:
376700083
ADMINISTRATOR:SCHWARTZ, ASHLEYFACILITY TYPE:
840
ADDRESS:6900 AMBROSIA LANETELEPHONE:
(760) 331-6028
CITY:CARLSBADSTATE: CAZIP CODE:
92011
CAPACITY:110CENSUS: 82DATE:
10/08/2015
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
05:00 PM
MET WITH:Site Director Ashley SchwartzTIME COMPLETED:
05:45 PM
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Licensing Program Analyst, Joelle Redding, made an unannounced visit to follow up on a self reported incident wherein a 6 year old child fell off the monkey bars on the playground, breaking his arm.

LPA interviewed staff and toured the playground. The play structure is age appropriate for elementary school children. The bars are about six feet off the ground. Staff Samantha Raymond directly observed the child begin to cross the monkey bars. She stated that he was quite coordinated and had done it many times before. Yesterday, however, he slipped off or let go while reaching for the third rung and fell down to his knees with his hands out to brace himself, his wrist taking the brunt of the fall. First aid was immediately applied and the parent was called. He was transported to the doctor where he was diagnosed with a broken arm.

During the time of the incident, the facility was within ratio on the playground with two staff and no more than 28 children. Staff directly observed the incident and responded appropriately. The facility staff reported the incident timely. The child is expected to return to school on Monday.

No deficiencies are cited.
SUPERVISOR'S NAME: Carl SheltonTELEPHONE: (619) 767-2212
LICENSING EVALUATOR NAME: Joelle ReddingTELEPHONE: (619) 767-2222
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2015
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2015
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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