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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270267
Report Date: 10/25/2021
Date Signed: 10/25/2021 09:42:48 AM

Document Has Been Signed on 10/25/2021 09:42 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 CENTERFACILITY NUMBER:
304270267
ADMINISTRATOR:VASQUEZ, JENNYFACILITY TYPE:
830
ADDRESS:705 EAST BIRCH STREETTELEPHONE:
(714) 256-2010
CITY:BREASTATE: CAZIP CODE:
92821
CAPACITY: 52TOTAL ENROLLED CHILDREN: 42CENSUS: 22DATE:
10/25/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Jenny Vasquez, Director TIME COMPLETED:
09:45 AM
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Licensing Program Analyst, (LPA) P Rivas conducted a case management visit to correct room numbers used under this license.
Director reports she has 42 enrolled children because a couple of them are part time.

During annual inspection there was a question of which rooms were to be used under this license. Per LPA Rivas and LPM Lopez's review of facility records that this license can have use of Rooms 1, 2, 3, and 4.

Therefore this facility will be licensed in the Rooms 1, 2, 3, 4.

An Inspection and exit interview was completed with director. The report was reviewed and discussed. Appeal Rights were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights.
The facility representative was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. The “Notice of Site Visit” must be posted on or adjacent to the door. Failure to post will result in Civil Penalties of $100.00.
SUPERVISORS NAME: Rina Lopez
LICENSING EVALUATOR NAME: Pat Rivas
LICENSING EVALUATOR SIGNATURE: DATE: 10/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/25/2021
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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