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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343604948
Report Date: 06/19/2024
Date Signed: 06/19/2024 01:01:58 PM

Document Has Been Signed on 06/19/2024 01:01 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:CHILDTIME CHILDREN'S CENTERFACILITY NUMBER:
343604948
ADMINISTRATOR/
DIRECTOR:		ROBERTS, DONYALEFACILITY TYPE:
850
ADDRESS:7901 LAGUNA BOULEVARDTELEPHONE:
(916) 691-3800
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 95TOTAL ENROLLED CHILDREN: 95CENSUS: 26DATE:
06/19/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Juanita Belen TIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
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On 06/19/2024, Licensing Program Analyst Katy Velazquez (LPA) conducted a field visit to the facility for the purpose of a case management inspection. LPA arrived at the facility and was met by Assistant Director Juanita Belen (D1). LPA disclosed the purpose of the inspection and was granted entrance into the facility. LPA toured the facility and observed 26 preschool aged children being supervised by 4 staff members. LPA determined, through accessing Guardian, that all required adults were background cleared and associated to the license.

On 06/12/2024, a staff member aggressively grabbed a day-care child and moved the child's body in a shaking motion. This unusual incident was not reported to the Department. Any unusual incident that threatens the physical or emotional health or safety of any child is to be reported. The lack of reporting poses/posed a risk to the health, safety, and personal rights of person(s) in care. As a result, a Type-B deficiency was cited on a subsequent 809-D page.

An exit interview was conducted, and the report was reviewed with Assistant Director Belen. LPA provided D1 with Licensee Appeal Rights. A Notice of Site visit was posted by LPA and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Katy Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/19/2024
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 06/19/2024 01:01 PM - It Cannot Be Edited


Created By: Katy Velazquez On 06/19/2024 at 12:42 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: CHILDTIME CHILDREN'S CENTER
FACILITY NUMBER: 343604948

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/19/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/26/2024
Section Cited
CCR
101212(d)(C)

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Reporting Requirements (d) Upon the occurrence,... a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the
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Directors Donyale Roberts and Junita Belen will watch “Child Care Reporting Requirements” on the CCLD website and report to LPA, via email, with a signed statment that they have done so by 5 PM on 06/26/2024.
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Department within seven days... (1)...(C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child. This requirement was not met as evidenced by an unusual incident occurring on 06/13/2024 which was not reported to the Department.
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 An LIC 624 Unusual Incident Report will be submitted via email to LPA by 5 PM on 06/26/2024.

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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:Karyn Guerra
LICENSING EVALUATOR NAME:Katy Velazquez
LICENSING EVALUATOR SIGNATURE:
DATE: 06/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/19/2024


LIC809 (FAS) - (06/04)
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