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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304270267
Report Date: 09/16/2022
Date Signed: 09/19/2022 11:26:07 AM

Document Has Been Signed on 09/19/2022 11:26 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: 52CENSUS: 30DATE:
09/16/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:31 PM
MET WITH:Jenny Vasquez, directorTIME COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Dean Valencia conducted an unannounced Case Management Inspection, met with director Jenny Vasquez to discuss the Lead Sampling testing conducted. A physical plant walk through was conducted and census of staff/children was taken in individual classrooms. During the inspection there were 30 children present and 8 staff. During the inspection, LPA Valencia ensured the Lead Sample Report is posted.

Director stated that they single faucet that reported exceedance lead levels has since been replaced. The supply line to this faucet replaced as well. Director stated that they are in the process of a flushing of this line and faucet line, to then proceed with a second lead test. Once the second lead test is completed a correction and test result will be submitted to LPA.
SUPERVISORS NAME: Judy Hanson
LICENSING EVALUATOR NAME: Dean Valencia
LICENSING EVALUATOR SIGNATURE: DATE: 09/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/16/2022
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 09/19/2022 11:26 AM - It Cannot Be Edited


Created By: Dean Valencia On 09/16/2022 at 03:12 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
, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: CHILDTIME CHILDREN'S CENTER
FACILITY NUMBER: 304270267

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/16/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/14/2022
Section Cited

101700.3

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101700.3 California Lead Action Level at Child Care Centers (b) Testing results with fractional ppb readings of 0.5 ppb or greater shall be rounded up to the nearest whole number, before comparing to the Action Level. (1) A result with values of 5.5 ppb or greater shall be deemed an Action Level Exceedance.
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The director has taken steps to fix the faucet and return the water line to levels of lead below 5.5 ppb. The correction for this will be subnmitted to LPA by 10/14/22.
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The above was not met as evidenced by:
The facility registered a single faucet in the facility with lead levels exceeding 5.5ppb.
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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:Judy Hanson
LICENSING EVALUATOR NAME:Dean Valencia
LICENSING EVALUATOR SIGNATURE:
DATE: 09/16/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/16/2022


LIC809 (FAS) - (06/04)
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