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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700080
Report Date: 08/09/2024
Date Signed: 08/09/2024 11:14:14 AM

Document Has Been Signed on 08/09/2024 11:14 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
SAN DIEGO N. CC RO, 7575 METROPOLITAN DR STE 110
SAN DIEGO, CA 92108
FACILITY NAME:CARLSBAD EDUCATIONAL FOUNDATION - JEFFERSON ELEM.FACILITY NUMBER:
376700080
ADMINISTRATOR/
DIRECTOR:
LYNNE LARUSSAFACILITY TYPE:
840
ADDRESS:3743 JEFFERSON STREETTELEPHONE:
(760) 573-9839
CITY:CARLSBADSTATE: CAZIP CODE:
92008
CAPACITY: 250TOTAL ENROLLED CHILDREN: 229CENSUS: 127DATE:
08/09/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Area Manager, Jennifer RodriguezTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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LPAs (Licensing Program Analysts) Saraliz Velando and Stefani Mutilau, conducted an unannounced follow up of a self-reported incident that occurred on 7/31/24. On 7/31/24, a 4 year old child (Child #1) slipped off a small Kindergarten chair while trying to step up onto it and sustained a laceration on his chin.

LPA spoke with Staff #1, who was in Room 602 where the incident occured. Staff #1 stated that a child notified the teacher that child #1 fell. Staff #1 took child #1 to the sink and gave him a wet paper towel to place on his chin.

LPA also spoke with Staff #2 that stated that she was called on the Walkie and heard there was an emergency in room 602. Staff #2 was told by Staff #1 that the child’s foot slipped off the chair when he tried to step on the chair and went forward and hit the back of the chair with his chin and resulted in a laceration. Staff #1 then took the child to the sink and gave him a wet paper towel to help stop the bleeding. She also had him take some deep breaths to help calm him down and had him apply pressure to stop the bleeding. Staff #3 went to get an ice pack and call the parents. Staff #2 told the LPA that the child stated that he wanted to be taller and that is why he tried to step on to the chair.

Staff #1 stated that when the mother arrived and evaluated the child, she decided it was not necessary to seek medical attention, as she is a physician assistant herself and decided that she would just place a butterfly bandage on his chin. Child #1 was able to return to school the following day.

The ratio was 3 staff to 12 children at the time of incident, adequate supervision was in place, and staff responded appropriately. The facility reported the incident timely. The chairs for the children in room 602 are age appropriate. It seems that this was a random accident. No deficiencies were cited. A notice of site visit was posted and must remain for 30 days.
SUPERVISORS NAME: Joelle Redding
LICENSING EVALUATOR NAME: Saraliz Velando
LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2024
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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