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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300610695
Report Date: 12/03/2021
Date Signed: 12/06/2021 11:00:24 AM

Document Has Been Signed on 12/06/2021 11:00 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:CHILDTIME LEARNING CENTERFACILITY NUMBER:
300610695
ADMINISTRATOR:SILVA, ANDREAFACILITY TYPE:
850
ADDRESS:13881 PROSPECT AVETELEPHONE:
(714) 544-6820
CITY:SANTA ANASTATE: CAZIP CODE:
92705
CAPACITY: 103TOTAL ENROLLED CHILDREN: 103CENSUS: 55DATE:
12/03/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:44 AM
MET WITH:Andrea Silva, DirectorTIME COMPLETED:
11:00 AM
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Licensing Program Analysts (LPA) Torrence conducted a case management inspection to follow up on a self-report unusual incident that was submitted to CCL Regional Licensing Office on 11/24/2021. It was reported by Amy Valentin, Lead Teacher. Per Mrs. Valentin, the unusual incident occurred on 11/23/2021, at 11:15 a.m.

Mrs. Valentin stated the following: Staff #1 notified the director that she found the child in the classroom by himself. Staff #1 reported children went outside at around 11:15 a.m. and was found by Staff #1 at 11:23 a.m. in classroom D by himself. Mrs. Valentin stated the classroom video footage was reviewed by the District Manager and it confirmed child was left in the classroom for about 8 minutes.

During today's inspection LPA Torrence met with Director Andrea Silva and tour the facility. There were 55 children present; with five staff supervising. A review of staff records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances. During today's inspection staff members were interviewed and stated the following:

Staff #1 reported she went to the classroom to get her belongings and saw child standing alone at the front door of the classroom. Staff #2 reported thought child had passed her to go outside to play, after the face to name check and did not notice child had went back in the classroom, until Staff #1 found child in the classroom alone.

LPA was unable to review the video footage as it is kept at the district office; however, the District Manager did review the video and confirmed child was left in the classroom alone.

Based on LPA’s interviews conducted with staff and video footage, the following deficiency is being cited in accordance with California Code of Regulations, Title 22, Division 12, Section 101229(a)(1) Responsibility for Providing Care and Supervision. The deficiency is being cited on the attached 809D.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Stacy Torrence
LICENSING EVALUATOR SIGNATURE: DATE: 12/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2021
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 12/06/2021 11:00 AM - It Cannot Be Edited


Created By: Stacy Torrence On 12/03/2021 at 08:54 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: CHILDTIME LEARNING CENTER
FACILITY NUMBER: 300610695

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/03/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/07/2021
Section Cited
CCR
101229(a)(1)

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101229(a)(1) Responsibility for Providing care and Supervision. (a) The licensee shall provide care and supervision....(1) No child(ren) shall be left without the supervision of a teacher at any time...Supervision shall include visual observation. Requirement is not met as evidenced by: Based on interviews and review of video footage, the facility failed
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Per Director Ms. Silva, she sent out a remainder of the facility's face to name protocol via email, on 11/29/2021, to all teachers, indicating a visit will be made to endure they are in compliance. Per Ms. Silva, she will send LPA a copy of a list of teachers' signatures who received and reviewed the protocal reminder by due date of 12/07/2021. During today's inspection, LPA received a copy of the protocol reminder email that was sent out.
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to provide supervision, as Staff #1 found child left alone in the classroom. This poses an immediate risk to the health and safety of the 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:Thuy Ho
LICENSING EVALUATOR NAME:Stacy Torrence
LICENSING EVALUATOR SIGNATURE:
DATE: 12/03/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/03/2021


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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: CHILDTIME LEARNING CENTER
FACILITY NUMBER: 300610695
VISIT DATE: 12/03/2021
NARRATIVE
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If the facility receives a Type 'A' violation the licensee shall post and provide copies of the report to parents/guardians of the children in care at the facility by the next business day and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days. The licensee is to keep Acknowledgement Receipt (LIC9224) signed by parents in each child’s file.

An exit interview was completed. The report was reviewed and discussed. Appeal Rights were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the licensing office within 15 business days. The facility representative was informed that the 'Notice of Site Visit' must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The 'Notice of Site Visit' must be posted on or adjacent to the door. Failure to post Type A Reports for 30 days will result in a civil penalty of $100.00.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Stacy Torrence
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2021
LIC809 (FAS) - (06/04)
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