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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 330911037
Report Date: 08/26/2021
Date Signed: 08/26/2021 01:27:57 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/27/2021 and conducted by Evaluator Lakesha Edwards
PUBLIC
COMPLAINT CONTROL NUMBER: 10-CC-20210527085726
FACILITY NAME:CHILDTIME CHILDREN'S CENTERFACILITY NUMBER:
330911037
ADMINISTRATOR:SURIATI C. CAFAROFACILITY TYPE:
830
ADDRESS:14700 PERRIS BLVD.TELEPHONE:
(951) 242-0707
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92553
CAPACITY:24CENSUS: 8DATE:
08/26/2021
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Suriati Cafaro-DirectorTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Staff did not change infants diapers timely
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) La Kesha Edwards made an unannounced visit to the facility to deliver the findings for the above allegation. COVID-19 screening questions were conducted prior to entry.

An initial tele-visit was conducted on 6/2/2021 via FaceTime. LPA met with the Director, Suriati Cafaro. LPA toured the facility and took census.

It is alleged staff did not change an infant diaper timely. LPA conducted interviews with staff and other pertinent parties regarding the allegation. In interviews conducted, it was stated that one infant had feces oozing out from the top of the diaper and on to the floor. The staff member that was caring for the infant S1 refused to change the infant’s diaper. This staff member (S1) was asked by another staff member (S2) to please change the infants diaper after the child was observed on the floor playing in their poop. (Continued on 9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Lakesha Edwards
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 10-CC-20210527085726
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: CHILDTIME CHILDREN'S CENTER
FACILITY NUMBER: 330911037
VISIT DATE: 08/26/2021
NARRATIVE
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(Continued from 9099)

The infant had to be cleaned and changed by another staff member (S2). LPA reviewed the diaper changing log for the date of 5/25/2021 and verified that there was a note for the infant that the child had a bowel movement, needed to be changed and went home early. Director stated (S1) was spoken to regarding this behavior and no longer works for the facility.

Based on the information gathered during the investigation and the violation of the a child in care was not changed timely after the child had pooped and S1 refusing to change the childthe preponderance of evidence standard has been met therefore; the above allegation was found to be SUBSTANTIATED.

See LIC9099D for cited deficiency. Appeal rights discussed and a copy of this report was provided to the licensee on this date.



An Exit interview was conducted and a copy of this report and A NOTICE OF SITE VISIT WAS ISSUED. LPA VERIFIED THAT IT WAS POSTED IN A PROMINENT LOCATION AT THE FACILITY BEFORE LEAVING.

This report must be available for public view for the next three years.

SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Lakesha Edwards
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 10-CC-20210527085726
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: CHILDTIME CHILDREN'S CENTER
FACILITY NUMBER: 330911037
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/26/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/02/2021
Section Cited
CCR
101428(b)(2)
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101428(b)(2) Infant Care Personal Services (b) The infant shall be kept clean and dry at all times. (2) Each infant's clothing and diapers shall be changed as often as necessary to ensure that the infant is clean and dry at all times.

This requirement was not met as evidenced by:
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Licensee agrees to review Title 22 Regulations 101428(b)(2) Infant Care Personal Services (b) and have a refresher training with staff to remind staff that infants in care diapers and clothing shall be changed as often as needed to ensure infants are dry and clean at all times. Director will provide a list of staff that attended the training with their signatures. Plan of correction will be provided to LPA by POC due date.
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Based on interviews conducted during the investigation and documents obatined, a child in care was not changed timely after the child had pooped that oozed out of the diaper and onto the floor. S1 was asked by S2 who entered the infant room and and observed the child on the floor playing in their poop to change the child, S1 refused to change the child. S2 had to clean the floor and the child.

This poses a potential risk to the Health and Safety of 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.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Lakesha Edwards
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3