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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073401396
Report Date: 03/15/2021
Date Signed: 03/25/2021 02:34:36 PM

Document Has Been Signed on 03/25/2021 02:34 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:CHILDTIME CHILDREN'S CENTERFACILITY NUMBER:
073401396
ADMINISTRATOR:WEINMANN, STEPHANIEFACILITY TYPE:
850
ADDRESS:6635 ALHAMBRA AVENUE, STE. 300TELEPHONE:
(925) 947-6800
CITY:MARTINEZSTATE: CAZIP CODE:
94553
CAPACITY: 102TOTAL ENROLLED CHILDREN: 0CENSUS: 102DATE:
03/15/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Stephanie WeinmannTIME COMPLETED:
11:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) (Phyllis) Lisa Dyer and LPM Loretta Dyson conducted an announced Case Management Inspection. Due to the Covid-19 State of Emergency and the shelter-in-place mandate from the Governor’s office, the inspection was done via teleconference (Zoom).

It was disclosed during a Covid-19 Technical Assistance RAST teleinspection that director had failed to report to Community Care Licensing a Covid-19 case and instances where facility was closed.

The attached type B deficiency is cited today and must be corrected by the due date (see 809D). This report must be available for public review for 3 years.

Appeal rights will be e-mailed to the director.

Exit interview conducted.
SUPERVISORS NAME: Antranette Robinson
LICENSING EVALUATOR NAME: Phyllis Dyer
LICENSING EVALUATOR SIGNATURE: DATE: 03/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/15/2021
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 03/25/2021 02:34 PM - It Cannot Be Edited


Created By: Phyllis Dyer On 03/15/2021 at 12:38 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
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: CHILDTIME CHILDREN'S CENTER
FACILITY NUMBER: 073401396

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/15/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/29/2021
Section Cited
CCR
101212(d)

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Reporting Requirements...Items...shall be reported to the department within 10 working days following their occurrence..
This requirement was not met as evidenced by interview and document review: director did not
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Director will be required to contact CCL and document all cases of Covid and all cases where the facility was closed. Director will also be required to complete and provide an Unusual Incident Report for each occurrence.
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report to CCL after a Covid incident/school closures. This poses an potential health and safety risk to children in care.
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Failure to correct will result in a $100 per day civil penalty until corrected. Repeat violations are $250 per violation and $100 per day until corrected.

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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:Antranette Robinson
LICENSING EVALUATOR NAME:Phyllis Dyer
LICENSING EVALUATOR SIGNATURE:
DATE: 03/15/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/15/2021


LIC809 (FAS) - (06/04)
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