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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 330911037
Report Date: 10/18/2022
Date Signed: 10/18/2022 11:43:30 AM

Unsubstantiated


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
08/15/2022 and conducted by Evaluator Anastasia Flores
PUBLIC
COMPLAINT CONTROL NUMBER: 10-CC-20220815104413
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: 7DATE:
10/18/2022
UNANNOUNCEDTIME BEGAN:
11:06 AM
MET WITH:Jessica Bayer TIME COMPLETED:
11:52 AM
ALLEGATION(S):
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Staff is not providing adequate supervision
INVESTIGATION FINDINGS:
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On October 18, 2022 at 11:06 AM, Licensing Program Analyst (LPA) Anastasia Flores met with Childtime Children’s Center Interim Director, Jessica Bayer in regard to the above allegation. On 08/17/22 at 11:43 AM, LPA conducted a health and safety inspection of the facility and no immediate concerns were noted. Copies of incident reports for child #1 (C1), children’s roster and staff contact information was obtained. Interviews were conducted with four of six staff. Attempt to contact two staff was unsuccessful.

On August 15,2022 this agency received allegation that staff was not providing adequate supervision. Confidential interviews reported that Child #1 (C1) had received at least three injuries between the months of June 2022 to August of 2022 due to lack of supervision with the staff. Interview with S4 informed LPA that C1 wore soft sole shoes and that the facility has informed mom to have C1 wear other shoes to reduce the child from falling so much. Other confidential interviews disclosed that C1 received an injury to the head on at least four different occasions.
(continued on next page)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Anastasia Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2022
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 2
Control Number 10-CC-20220815104413
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: 10/18/2022
NARRATIVE
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Confidential interviews disclosed that S2 informed her staff would be reprimanded after looking at the nanny cam and that S2 also order another rug for the hard floor. Other confidential interviews denied the injuries occurred due to lack of supervision and that it was due to C1 continually wearing soft sole shoes and that the the injuries received was normal for the age.

Based on interviews and confidential record review, the allegations that staff is not providing adequate supervision may have occurred, however are not supported or proven by evidence Therefore, the allegation is UNSUBSTANTIATED at this time.

Exit interview conducted and a copy of the report along with the appeal rights were provided to Interim Director, Jessica Bayer

A NOTICE OF SITE VISIT WAS ISSUED AND LPA VERIFIED THAT IT WAS POSTED IN A PROMINENT LOCATION AT THE FACILITY BEFORE LEAVING. THE LICENSEE UNDERSTANDS THAT IT MUST REMAIN POSTED FOR THE NEXT 30 DAYS.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Anastasia Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2