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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408919
Report Date: 05/09/2022
Date Signed: 05/11/2022 02:53:21 PM

Document Has Been Signed on 05/11/2022 02:53 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:KID TIME, INC.FACILITY NUMBER:
073408919
ADMINISTRATOR:CASWELL, ANGELAFACILITY TYPE:
850
ADDRESS:2551 PLEASANT HILL ROADTELEPHONE:
(925) 930-6550
CITY:PLEASANT HILLSTATE: CAZIP CODE:
94523
CAPACITY: 29TOTAL ENROLLED CHILDREN: 23CENSUS: 14DATE:
05/09/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Angela CaswellTIME COMPLETED:
02:45 PM
NARRATIVE
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Amended report
On 5/9/22 at 1:15 pm Licensing Program Analysts (LPAs) Monica Mathur and Christina Watts conducted an Case Management inspection at Kid Time Inc - preschool component.

During a complaint investigation it was determined that facility failed to notify Licensing Department about an unusual incident involving recent outbreak of Hand, Foot, Mouth illness where at least 7 children fell ill. Facility also failed to notify the local health officer of communicable outbreak when more than 2 cases were confirmed. Failure to report unusual incident poses a potential risk to health and safety of children in care.
Deficiencies issued on 809-D. This report was reviewed with Director, Angela Caswell and a Notice of Site Visit was issued, must be posted for 30 consecutive days.

101212 Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event.
(1) Events reported shall include the following:
(A) Death of any child from any cause.
(B) Any injury to any child that requires medical treatment.
(C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child.
(D) Any suspected physical or psychological abuse of any child.
(E) Epidemic outbreaks.
(F) Poisonings.
(G) Catastrophes.
(H) Fires or explosions that occur in or on the premises.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE: DATE: 05/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2022
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 05/11/2022 02:53 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 05/10/2022 03:25 PM


Created By: Monica Mathur On 05/09/2022 at 01:31 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
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: KID TIME, INC.
FACILITY NUMBER: 073408919

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/10/2022
Section Cited
CCR
101212(d)(1)

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101212 Reporting Requirements (d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event [...]. This requirement is not met as evidenced by:
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By POC Due Date 5/10/22 Director agreed to send a written statement of understanding on this regulation and how facility will come into compliance moving forward.
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Facility failed to notify Licensing Department about an unusual incident involving recent outbreak of Hand, Foot, Mouth illness where at least 7 children fell ill. This poses a potential risk to halth and safety of children in care.
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Type B
05/10/2022
Section Cited
CCR101212(g)(1)

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101212 Reporting Requirements: (g)The items specified in (d)(1)(E) through (G) above shall also be reported to the local health officer when appropriate pursuant to Title 17, California Code of Regulations, Title 17, Section 2500.(1)The licensee shall report to the local health officer all outbreaks or suspected outbreaks involving two or more children of any communicable disease [...]. This requirement is not met as evidenced by:
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By POC Due Date 5/10/22 Director agreed to send a written statement of understanding on this regulation and how facility will come into compliance moving forward.
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Facility failed to notify the local health officer of communicable outbreak of Hand, Foot, Mouth when more than 2 cases were confirmed. This poses a potential risk to health and safety of 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:Sherelle Johnson
LICENSING EVALUATOR NAME:Monica Mathur
LICENSING EVALUATOR SIGNATURE:
DATE: 05/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/09/2022


LIC809 (FAS) - (06/04)
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