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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343604948
Report Date: 07/05/2024
Date Signed: 07/05/2024 01:00:20 PM

Document Has Been Signed on 07/05/2024 01:00 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: 27DATE:
07/05/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Donyale RobertsTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
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On 07/05/2024, Licensing Program Analyst Katy Velazquez (LPA) conducted a field visit to the facility for the purpose of a Case Management inspection as a result of a self reported Unusual Incident Report dated 06/25/2024. LPA arrived at the facility and was met by Director Donyale Roberts (D1). LPA disclosed the purpose of the inspection and was granted entrance. LPA toured the facility and observed 27 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 06/25/2024, a child was left on the playground when the teachers and children returned to their classroom. Another classroom was outside at the same time, and the staff members for this classroom maintained visual supervision of the child until the child could be returned to their classroom. As a result, a Type-A deficiency was cited on a subsequent 809-D page. LPA informed D1 that this deficiency is defined as a repeat as this is the 2nd time within a 12 month period that the facility has been cited for a lack of supervision. D1 acknowledges, that FOR TYPE A DEFICIENCIES ONLY upon receipt, licensee shall post LIC 9099-D with Type A deficiencies for 30 days and provide copies of this licensing report to parents/guardians of children in care at the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. LIC 9224 must be signed by parents/guardians and kept with the children's forms as a receipt whenever any Type A documents are provided by the licensee.

An exit interview was conducted, and the report was reviewed with Director Roberts. 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: 07/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/05/2024
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 07/05/2024 01:00 PM - It Cannot Be Edited


Created By: Katy Velazquez On 07/05/2024 at 11:42 AM
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: 07/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/08/2024
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time...
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Director Roberts will conduct one-on-one training regarding supervision of children with both staff members who were resonsible for the supervision of the child who was left on the playground. The staff members will sign a statement confirming that they recieved this training. The statements will be emailed
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This requirement was not met as evidenced by a child being left by the teacher on the playground when the class exited the playground and entered the classroom. The lack of supervision poses/posed a health, safety or personal rights risk to persons in care.
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to LPA by 5:00 PM on 07/08/2024.

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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: 07/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/05/2024


LIC809 (FAS) - (06/04)
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