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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700078
Report Date: 09/30/2021
Date Signed: 09/30/2021 05:43:40 PM

Document Has Been Signed on 09/30/2021 05:43 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: 0CENSUS: 51DATE:
09/30/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Bridget NicholsTIME COMPLETED:
05:55 PM
NARRATIVE
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On September 30, 2021 at 2:10 p.m. Licensing Program Analyst (LPA) Leilani Curtis conducted an unannounced annual inspection. In addition to the annual inspection LPA addressed the licensee’s request to add and remove classrooms from the license. Upon arrival LPA met with Area Manager Bridget Nichols and toured the facility. Also present were a total of 51 children in the following classrooms:
  • Lunch Area: 27 children with staff members Lauren Henry and Ruby Solis.
  • Kindergarten Play Area: 11 children with staff members Yisel Martinez and Shobana Munirathinam.
  • Room 711: 13 children with staff member Yeny Ortiz.

The licensee has not exceeded the approved capacity of the fire clearance for the facility. Appropriate ratios and capacity were observed. All children are supervised, including visual supervision, of a teacher. Staff members have the required background clearances and are associated to the facility. There are no excluded individuals present. The facility is clean, safe, sanitary, and in good repair to ensure the safety and well-being of children, employees and visitors. Furniture and age appropriate equipment is in good condition indoors and outdoors. The food preparation area is clean. All foods and beverages capable of supporting the rapid and progressive growth of microorganisms that can cause food intoxication's are stored in covered containers at 45 degrees F or less if required. Storage containers for solid waste are covered with tight-fitting lids. Drinking water is readily accessible inside and outside the classroom. Restrooms are maintained with operational toilets and faucets with appropriate temperature. The children's toilets and hand washing facilities are sanitary. All disinfectants, cleaning solutions, and other hazardous items are inaccessible to children. Storage area for poisons is locked.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Grace Curtis
LICENSING EVALUATOR SIGNATURE: DATE: 09/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/30/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
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: CARLSBAD EDUCATIONAL FOUNDATION-PACIFIC RIM ELEM.
FACILITY NUMBER: 376700078
VISIT DATE: 09/30/2021
NARRATIVE
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The outdoor activity space surface is maintained in a safe condition and free of hazards. Playground equipment is safe and free of sharp, loose or pointed parts. The areas around and under high climbing equipment, swings, slides & similar equipment have cushioning to absorb the impact of a fall. The outdoor play area is fenced and there are covered areas for shade. There are no bodies of water or weapons at this facility. Fire drills are being conducted every 6 months. There is an operational carbon monoxide detector at the facility that meet statutory requirements. First Aid/CPR certifications were reviewed and are in compliance. Admission Agreement forms were not available for review. Emergency information forms and medical assessment forms were reviewed for some children. Staff records contain documentation of education, training, and/or experience. Health screening forms were reviewed for some staff. Sign in/sign out sheets are well maintained. The person who signs the child in/out uses their full legal signature and records the time of day. Menus are posted where an authorized representative can view them.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Grace Curtis
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021
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: CARLSBAD EDUCATIONAL FOUNDATION-PACIFIC RIM ELEM.
FACILITY NUMBER: 376700078
VISIT DATE: 09/30/2021
NARRATIVE
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The facility is currently licensed to operate in the following rooms: 202, 301, 302, 502, 601, 701, 711 and the multipurpose room. The licensee has requested to remove rooms 502, 601, 701 from the license and add rooms 405 and the STEAM Lab. The capacity will continue to be 140 children ages 5-12 years old. An updated fire clearance for the requested rooms was granted on 9/16/2021.

A license for 140 children (ages 5-12 years old) in rooms 202, 302, 405, 711, multipurpose room and STEAM lab is granted and effective today’s date, 9/30/2021. An updated license will be sent for posting.

See LIC809D for cited deficiency.

The following handouts were provided to the director:
  • Updated Coronavirus 2019 Industry Guidance for Child Care Settings PIN 21-18-CCP.
  • California Department of Public Health updated June 29,2021 Child Care Industry Guidance.

LPA obtained an updated Emergency Disaster Plan for Child Care Centers- LIC610A, Personnel Report-LIC500 and Designation of Facility Responsibiity-LIC308.

The area manager was advised to regularly visit the Community Care Licensing WEB SITE: http://www.ccld.ca.gov/ for quarterly updates and updated regulation information and the Duty Line was provided: (619) 767-2248. LPA also discussed California Megan's Law and LPA provided the area manager with the following website: www.meganslaw.ca.gov

An exit interview was conducted with Ms. Nichols and Appeal Rights (LIC 9058 1/16) were discussed. Ms. Nichols 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 area manager post notice of site visit.
SUPERVISORS NAME: Tashima Daniel
LICENSING EVALUATOR NAME: Grace Curtis
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/30/2021 05:43 PM - It Cannot Be Edited


Created By: Grace Curtis On 09/30/2021 at 05:19 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-PACIFIC RIM ELEM.
FACILITY NUMBER: 376700078

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/30/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/08/2021
Section Cited
CCR
101219(a)

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Admission Agreements: (a) The licensee and the child's authorized representative shall jointly complete a current individual written admission agreement for the child. This documentation shall be maintained at the child care center and shall be available for review. This requirement was not met as evidenced by:
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Area Manager Nichols states that she will submit copies of the admission agreement forms for the 10 children's files reviewed to LPA via email by POC due date.
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Based on LPA's record review the facility did not have admission agreement forms available for the 10 children's files reviewed today. This poses a potential health and safety risk 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:Tashima Daniel
LICENSING EVALUATOR NAME:Grace Curtis
LICENSING EVALUATOR SIGNATURE:
DATE: 09/30/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/30/2021


LIC809 (FAS) - (06/04)
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