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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343624159
Report Date: 09/18/2025
Date Signed: 09/18/2025 02:16:54 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/12/2025 and conducted by Evaluator Erwina Pascual-Golamco
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20250812143246
FACILITY NAME:CHILDTIME LEARNING CENTERFACILITY NUMBER:
343624159
ADMINISTRATOR:SAMS, KATHERINEFACILITY TYPE:
850
ADDRESS:101 HAZELMERE DRIVETELEPHONE:
(916) 984-3800
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY:108CENSUS: 38DATE:
09/18/2025
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Katherine SamsTIME COMPLETED:
02:50 PM
ALLEGATION(S):
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Staff did not maintain staff records at the facility
INVESTIGATION FINDINGS:
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Licensing Program Analyst Erwina Pascual-Golamco (LPA) met with Facility Representative Katherine Sams (FR) to deliver findings of the above allegation.

Throughout the course of investigation, LPA conducted observations, reviewed records, and conducted interview with Facility Representative. During LPA’s initial complaint visit on 08/20/25, LPA reviewed sample of staff records and files and observed 3 out of 3 staff sample files did not have the required documentation for LPA to review. Based on LPA record review and interview with Facility Representative, the preponderance of evidence standard has been met, therefore the above allegation is SUBSTANTIATED.

A Title 22 deficiency is cited on LIC 9099-D. Exit interview was conducted and report was reviewed with Facility Representative, Katherine Sams. Appeal rights were provided. Notice of site visit was given and must remain posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jeevun Birk-Miller
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025
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 03-CC-20250812143246
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: CHILDTIME LEARNING CENTER
FACILITY NUMBER: 343624159
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/02/2025
Section Cited
CCR
101217(d)
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101217 Personnel Records (d) All personnel records shall be maintained at the child care center and shall be available to the licensing agency for review. This requirement is not met as evidenced by:
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Facility Representative (FR) stated she will audit staff files and will email LPA attestation that staff files are complete by end of business day POC due date.
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During LPA’s initial complaint visit on 08/20/25, LPA reviewed sample of staff records and files and observed 3 out of 3 staff sample files did not have the required documentation for LPA to review.
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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: Jeevun Birk-Miller
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/12/2025 and conducted by Evaluator Erwina Pascual-Golamco
PUBLIC
COMPLAINT CONTROL NUMBER: 03-CC-20250812143246

FACILITY NAME:CHILDTIME LEARNING CENTERFACILITY NUMBER:
343624159
ADMINISTRATOR:SAMS, KATHERINEFACILITY TYPE:
850
ADDRESS:101 HAZELMERE DRIVETELEPHONE:
(916) 984-3800
CITY:FOLSOMSTATE: CAZIP CODE:
95630
CAPACITY:108CENSUS: 38DATE:
09/18/2025
UNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Katherine SamsTIME COMPLETED:
02:50 PM
ALLEGATION(S):
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9
Staff spoke inappropriately to children in care
Staff did not provide adequate supervision to children in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst Erwina Pascual-Golamco (LPA) met with Facility Representative (FR) Katherine Sams (FR) to deliver findings of the above allegations.
Throughout the course of the investigation, LPA toured the facility, observed staff providing care to children, and conducted interviews. LPA observations, interviews and statements were inconsistent to corroborate the allegations Staff spoke inappropriately to children in care and Staff did not provide adequate supervision to children in care. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview was conducted and report was reviewed with Facility Representative Katherine Sams. Appeal rights were provided, and a Notice of Site visit was given to FR who will post it where visible to parents/guardians for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jeevun Birk-Miller
LICENSING EVALUATOR NAME: Erwina Pascual-Golamco
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3