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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 100406618
Report Date: 11/01/2021
Date Signed: 11/01/2021 11:15:18 AM

Document Has Been Signed on 11/01/2021 11:15 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, 1310 E. SHAW AVE,
FRESNO, CA 93710
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: 75TOTAL ENROLLED CHILDREN: 75CENSUS: 29DATE:
11/01/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Director - Kristina DiazTIME COMPLETED:
11:30 AM
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On 11/01/2021, Licensing Program Analyst (LPA) Luisa Gavoutian conducted an unannounced case management inspection. LPA met with Director Kristina Diaz, toured the facility, and took a census. The purpose of today’s inspection was to address a deficiency that was observed during the course of a complaint investigation.

The complaint investigation revealed that on 08/20/2021, Child 1 ingested “play foam” in the classroom. Child 1 is enrolled in the “Twos” classroom and is two years of age. Staff 2 stated the children were playing with the “play foam” on that date and some had gotten on the floor. Staff 2 stated that as Staff 2 was in the process of sweeping the fallen “play foam” off the ground, Child 1 picked some up and put some in in their mouth. Staff 2 stated that they attempted to take the “play foam” out of Child 1’s mouth, but Child 1 had already swallowed it. On 08/31/2021, LPA conducted a site visit and observed the “play foam,” which was stored in a zip-top bag in a cabinet in the classroom, and was not in original packaging. LPA searched the product online and observed that the manufacturer’s recommended age of all “play foam” and similar products on the market were intended for children 36 months – 6 years old. LPA observed warning labels on the products’ packaging stating “CHOKING HAZARD -- Small parts. Not for children under 3 yrs.” This product was not age-appropriate and should not have been used in the “Twos” classroom, where all children are two years of age.

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

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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: CHILDTIME CHILDCARE, INC.
FACILITY NUMBER: 100406618
VISIT DATE: 11/01/2021
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"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
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Document Has Been Signed on 11/01/2021 11:15 AM - It Cannot Be Edited


Created By: Luisa Gavoutian On 11/01/2021 at 10:09 AM
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
, 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
101239(m)

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Fixtures, Furniture, Equipment and Supplies; (m) All play equipment and materials used by children shall be age-appropriate. This requirement was not met as evidenced by:

Based on observation and interview,
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Director stated the “play foam” has been removed from the classroom and is no longer in use. Director stated that she shall submit a written statement detailing how the facility will ensure that play equipment and materials used by children will be age-appropriate and shall be submitted to CCL by 11/02/2021.
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Licensee failed to provide age-appropriate play equipment and material by allowing two-year-old children to play with “play foam” that is intended for children age three and older and can be a choking hazard. 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.
SUPERVISOR'S 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


LIC809 (FAS) - (06/04)
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