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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700080
Report Date: 04/14/2023
Date Signed: 04/14/2023 10:28:40 AM

Document Has Been Signed on 04/14/2023 10:28 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:CARLSBAD EDUCATIONAL FOUNDATION - JEFFERSON ELEM.FACILITY NUMBER:
376700080
ADMINISTRATOR:LYNNE LARUSSAFACILITY TYPE:
840
ADDRESS:3743 JEFFERSON STREETTELEPHONE:
(760) 331-5525
CITY:CARLSBADSTATE: CAZIP CODE:
92008
CAPACITY: 120TOTAL ENROLLED CHILDREN: 75CENSUS: 0DATE:
04/14/2023
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jennifer RodriguezTIME COMPLETED:
10:45 AM
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On 4/14/23 at 9:00am, Licensing Program Analysts (LPAs) Patrick Ma, Joelle Redding and Gerald Poindexter conducted an announced Case Management – Licensee Initiated inspection regarding adding rooms to license. Upon arrival, LPA’s met with Area Manager Jennifer Rodriguez. There were no children present, school was on spring break.

Application requesting to add rooms 707, 803, 806, and the auditorium to existing licensed room 804 and 805 was submitted to the Department on 3/27/23. Fire Inspection clearance was provided on 4/11/23. Increase/decrease in occupancy was not requested. However, during the visit, only room 707, auditorium, and main school lunch tables in front of the cafeteria were requested to be licensed as room 803, 804, 805, and 806 were under construction.

LPA's physically inspected Room 707 but auditorium room was locked. Auditorium was previously inspected and had a fire inspection on 4/11/23. No structural alterations have been made and Ms. Rodriguez stated that the room is only used during inclement weather and the backstage door is locked. Ms. Rodriguez stated room 707 will have a maximum occupancy of 35, not to exceed maximum capacity allowed per Fire Marshall requirements, and over flow will utilize picnic table outdoor space next to the room or utilize the auditorium. LPA recommends reevaluating the auditorium when rooms 804 and 805 are reinspected after construction.

There were sufficient age appropriate furnishings, toys, books and games available and no hazards were noted in room 707. Hand washing and toileting areas are in a safe, sanitary and operating condition at the 200’s building for boys and 400’s buildings for girls. Facility will need a waiver to use bathrooms located at the 600’s building and library/cafeteria.
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Patrick Ma
LICENSING EVALUATOR SIGNATURE: DATE: 04/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/14/2023
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: CARLSBAD EDUCATIONAL FOUNDATION - JEFFERSON ELEM.
FACILITY NUMBER: 376700080
VISIT DATE: 04/14/2023
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Outdoor capacity is not affected. Room occupancy and children ratios must always be maintained.

No deficiency observed during the visit. Additional rooms 707 and the auditorium are granted effective today.

Exit interview conducted and report was reviewed with the facility representative Jennifer Rodriguez. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Renesha Askew
LICENSING EVALUATOR NAME: Patrick Ma
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023
LIC809 (FAS) - (06/04)
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