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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300611708
Report Date: 08/24/2021
Date Signed: 08/25/2021 09:54:21 AM

Document Has Been Signed on 08/25/2021 09:54 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 CHILDREN'S CENTER INC.FACILITY NUMBER:
300611708
ADMINISTRATOR:GUERECA, IRENEFACILITY TYPE:
850
ADDRESS:12421 SPRINGDALE STTELEPHONE:
(714) 894-4250
CITY:GARDEN GROVESTATE: CAZIP CODE:
92845
CAPACITY: 80TOTAL ENROLLED CHILDREN: 0CENSUS: 74DATE:
08/24/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Irene GuerecaTIME COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA), Nelson conducted an unannounced case management inspection of the facility on today's date. LPA Nelson toured the facility with the director, Irene Guereca and a census taken. The overall census observed was preschool 14 staff and 74 preschool children. A review of staff criminal clearance 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 or exemptions.

On 8/17/2021, an unusual incident report was filed with the Licensing office by the site director. The statement provided by the site director was that a two year child went under the fence found on the other side of the fence, the child was discovered by a another child's grandparent that a small child was in the school bus area parking zone.

LPA Nelson discussed the incident with the director and reviewed records interviewed staff and reviewed statements provided by the teachers who were out on the playground during the incident.LPA Nelson observed the playground and observed sections tied down after the incident. It was also observed that sections of the fence further down that were pushing out and open wide enough for a child from the school side to roll into a small alley section behind the preschool. The incident took place while the two year old children were out on the play yard. Child # 1 was observed by two teachers that Child # 1 was gazing out of the fence corner of the playground. The ground dips lows and the fence can push out rather at the time of the incident it did not appear to the teachers as though the fence could bend and a child could escape. Child # 1 was asked to come an play by Teacher # 1 rather Child # 1 was looking for their parents and would not leave the fence corner. Teacher # 1 went to tending to other children - Teacher # 1 did not observe when Child # 1 was able to roll under the fence and wander over to the Bus parking zone., none of the other teachers observed this incident occurring either.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Jordann Nelson
LICENSING EVALUATOR SIGNATURE: DATE: 08/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/24/2021
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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: CHILDTIME CHILDREN'S CENTER INC.
FACILITY NUMBER: 300611708
VISIT DATE: 08/24/2021
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Based on LPA’s interviews and record review which were conducted, the preponderance of evidence standard has been met, therefore the incident is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 12, Chapter 3 Section 101229 (a)(1) Responsibility to Provide Care and Supervison . Please refer to attached 809 D for documentation of deficiencies.

An exit interview was completed. The report was reviewed and discussed. Appeal Rights and deficiencies were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058 01/16) 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. If the facility receives a Type A violations, 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, and provide a copy to current and enrolling parents. The director is to keep Acknowledgement Receipt (LIC 9224) signed by parents in each child’s file.


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.
SUPERVISORS NAME: Patricia Magana
LICENSING EVALUATOR NAME: Jordann Nelson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/18/2021 01:32 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 11/16/2021 02:16 PM


Created By: Tina Nguyen On 08/24/2021 at 04:13 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: CHILDTIME CHILDREN'S CENTER INC.
FACILITY NUMBER: 300611708

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/24/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/24/2021
Section Cited
CCR
101229(a)(1)

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Resonsability for Providing Care and Supervison:a) The licensee shall provide care and supervision as necessary to meet the children's needs.1) No child(ren) shall be left without the supervision of a teacher at any time...
This requirement was not met as evidenced by:
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The director will immediately conduct a saftey sweep training for outdoor play and saftey with all staff and provide a signed copy of the training. The facility director will also review supervison protocols with staff ensuring that supervison is in place for all children at all times. A copy of this will be provided to CCL by 8/26/2021.
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Based on interviews and statements provided, the facility staff failed to supervise the two year old child on the playground whereby the child was able to slip away out of the Teachers sight. This poses an immidicate risk to the health and safety of the children in care.
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11/18/2021, LPA Nguyen accessed $500 civil penalty for absent of supervision.

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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:Tina Nguyen
LICENSING EVALUATOR SIGNATURE:
DATE: 08/24/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/24/2021


LIC809 (FAS) - (06/04)
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