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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 100406618
Report Date: 11/01/2021
Date Signed: 11/01/2021 11:17:00 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/26/2021 and conducted by Evaluator Luisa Gavoutian
PUBLIC
COMPLAINT CONTROL NUMBER: 04-CC-20210826164515
FACILITY NAME:CHILDTIME CHILDCARE, INC.FACILITY NUMBER:
100406618
ADMINISTRATOR:DIAZ, KRISTINAFACILITY TYPE:
850
ADDRESS:2091 SIERRA AVE.TELEPHONE:
(559) 297-5013
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY:75CENSUS: 29DATE:
11/01/2021
UNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Director Kristina DiazTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Staff gave child food that child was allergic to that is on file in the child's record.
INVESTIGATION FINDINGS:
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On 11/01/2021, Licensing Program Analyst (LPA) Luisa Gavoutian conducted an unannounced complaint inspection to provide findings for the above-mentioned allegation. LPA met with Director Kristina Diaz who accompanied LPA during tour of facility. LPA discussed the allegations and took a census. During the course of the investigation, LPA interviewed staff and witnesses and reviewed facility records. Investigation revealed that in June 2021 or July 2021 (exact date unknown), Child 1 was given a food that Child 1 is allergic to, as indicated in Child 1’s records. Child 1’s parent was notified on the day of the incident and Child 1 was monitored for possible allergic reactions. Staff 1 and Staff 2 admitted that the food in question was provided to Child 1 by accident and the staff that provided it was unaware of Child 1’s allergy to the food. Child 1 was administered allergy medication by Child 1’s parent, after consulting with Child 1’s physician telephonically. Following the incident, the facility electronically communicated with all families that the specific food item in question would no longer be allowed in the facility due to allergies.
(Continued on LIC 9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alice Juarez
LICENSING EVALUATOR NAME: Luisa Gavoutian
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 04-CC-20210826164515
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: CHILDTIME CHILDCARE, INC.
FACILITY NUMBER: 100406618
VISIT DATE: 11/01/2021
NARRATIVE
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Based upon observations, and information gathered through interviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated.

Per California Code of Regulations, Title 22, Division 12, Chapter 1, this deficiency is being cited on the attached LIC 9099-D.

"Upon receipt, licensee shall post and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months." The licensee was provided a copy of the "Fact Sheet" for AB 633 (Parent Notification Requirements), along with a copy of the relevant documents this date. A completed signed copy of the LIC 9224 will be placed in each child's file.

An exit interview conducted with Director Kristina Diaz. A copy of this report and Appeal Rights were provided and discussed with Director.

A Notice of Site Visit Form was posted to parent's board and must remain posted for 30 days, along with a copy of this report.
SUPERVISORS NAME: Alice Juarez
LICENSING EVALUATOR NAME: Luisa Gavoutian
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 04-CC-20210826164515
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: CHILDTIME CHILDCARE, INC.
FACILITY NUMBER: 100406618
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/01/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/02/2021
Section Cited
CCR
101227(b)(7)(B)
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Food Services; (B) A child shall not be served any food to which the child's record indicates he/she has an allergy. This requirement was not met as evidenced by:
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Director stated she shall submit a written statement detailing how she will ensure that no child is given food that records indicate child may be allergic to. This statement shall be submitted to CCL by 11/02/2021.
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Based on interviews and records review, facility staff served food to Child 1 that is indicated in Child 1’s record that Child 1 has a possible allergy to. This poses an immediate risk to the health, safety, or personal rights of children.
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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.
SUPERVISORS NAME: Alice Juarez
LICENSING EVALUATOR NAME: Luisa Gavoutian
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/26/2021 and conducted by Evaluator Luisa Gavoutian
PUBLIC
COMPLAINT CONTROL NUMBER: 04-CC-20210826164515

FACILITY NAME:CHILDTIME CHILDCARE, INC.FACILITY NUMBER:
100406618
ADMINISTRATOR:DIAZ, KRISTINAFACILITY TYPE:
850
ADDRESS:2091 SIERRA AVE.TELEPHONE:
(559) 297-5013
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY:75CENSUS: 29DATE:
11/01/2021
UNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Director Kristina DiazTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Lack of supervision resulting in an altercation between day care children
Child received injuries while in care
INVESTIGATION FINDINGS:
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On 11/01/2021, Licensing Program Analyst (LPA) Luisa Gavoutian conducted an unannounced complaint inspection to provide findings for the above-mentioned allegations. LPA met with Director Kristina Diaz who accompanied LPA during tour of facility. LPA discussed the allegations and took a census. During the course of the investigation, LPA interviewed staff and witnesses and reviewed facility records. Investigation revealed that on 08/20/2021, Child 1 ingested “play foam” in the classroom, which may have caused Child 1 to have diarrhea. No evidence was available for review to indicate that Child 1 had diarrhea or whether that diarrhea was caused by the “play foam.” On 08/26/2021, Child 2 was observed climbing on Child 1 while Child 1 was face-down on the floor. Staff 1 stated they witnessed the incident but was in the process of changing another child’s diaper and was unable to separate Child 1 and Child 2. Staff 2 was present in the classroom and did not witness the incident. Staff 1 called out to Staff 2 to bring the altercation to Staff 2’s attention. Child 1’s parent entered the classroom as Staff 1 was getting Staff 2’s attention. Investigation revealed that an altercation did occur between Child 1 and Child 2, but it is unclear whether it was due to lack of supervision.
(Continued on LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alice Juarez
LICENSING EVALUATOR NAME: Luisa Gavoutian
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 04-CC-20210826164515
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: CHILDTIME CHILDCARE, INC.
FACILITY NUMBER: 100406618
VISIT DATE: 11/01/2021
NARRATIVE
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The investigation revealed through interviews, LPA’s observations, and review of records, that although the above allegations may have happened or are valid, there is not a preponderance of evidence at this time to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Per California Code of Regulations, Title 22, Division 12, Chapter 1, no deficiency is cited during today's visit.

An exit interview conducted with Director Kristina Diaz. A copy of this report and Appeal Rights were provided and discussed with Director.

A Notice of Site Visit Form was posted on parent's board and must remain posted for 30 days.
SUPERVISORS NAME: Alice Juarez
LICENSING EVALUATOR NAME: Luisa Gavoutian
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 5