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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360910507
Report Date: 04/20/2022
Date Signed: 04/20/2022 04:45:28 PM

Document Has Been Signed on 04/20/2022 04:45 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:CHILDTIME CHILDREN'S CENTERSFACILITY NUMBER:
360910507
ADMINISTRATOR:CHARLENE BUNNELL-MCALISTERFACILITY TYPE:
850
ADDRESS:3656 RIVERSIDE DR.TELEPHONE:
(909) 591-9169
CITY:CHINO,STATE: CAZIP CODE:
91710
CAPACITY: 69TOTAL ENROLLED CHILDREN: 77CENSUS: 40DATE:
04/20/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Charlene Bunnelle-Mcalister- DirectorTIME COMPLETED:
04:45 PM
NARRATIVE
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During a complaint investigation visit, Licensing Program Analysts (LPAs), Rachel Zeron and Nasha King, were made aware that the facility recently had an outbreak of hand foot and mouth disease, which is still ongoing. The facility failed to report the outbreak on 04/15/2022 to Licensing within the 24 hour period. The Director indicated that as of this date, Licensing has not been notified of the outbreak. The facility is in violation of reporting requirements and will be issued a citation.

See LIC 809D for cited deficiencies. Appeal rights were discussed and a copy was provided.

An exit interview was conducted and a copy of this report was provided this date.
A notice if site visit was given and is required to be posted for the next 30 days.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Rachel Zeron
LICENSING EVALUATOR SIGNATURE: DATE: 04/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/20/2022
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 04/20/2022 04:45 PM - It Cannot Be Edited


Created By: Rachel Zeron On 04/20/2022 at 01:38 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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: CHILDTIME CHILDREN'S CENTERS
FACILITY NUMBER: 360910507

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/22/2022
Section Cited
CCR
101212(d)(E)

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Reporting Requirements: 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 Department within seven days following the occurrence of such event.Epidemic outbreaks.
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Director agreed to have an incident report sent to Licensing in regards to the outbreak within 24 hours.
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This requirement is not met as evidenced by:
Based on information recieved from the Director, there were apoximently 3 children with a confirmed case of the disease.

This poses a potential health, safety or personal rights risk to persons 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.
SUPERVISOR'S NAME:Kimberly Williams
LICENSING EVALUATOR NAME:Rachel Zeron
LICENSING EVALUATOR SIGNATURE:
DATE: 04/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/20/2022


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 04/20/2022 04:45 PM - It Cannot Be Edited


Created By: Rachel Zeron On 04/20/2022 at 04:00 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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: CHILDTIME CHILDREN'S CENTERS
FACILITY NUMBER: 360910507

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/20/2022
Section Cited
CCR
101212(d)(E)

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Reporting Requirements: 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 shall be submitted to the Department within seven days following the occurrence of such event. Epidemic outbreaks.
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Director agreed to have an incident report sent to Licensing in regards to the outbreak within 24 hours and agrees that all incidents noted under
section 101212 are to be reported to the department within 24 hours.
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This requirement is not met as evidenced by:
Based on information received from the Director, there were approximately 2 children with a confirmed case of Hands, Foot, and Mouth Disease.

This poses a potential health, safety or personal rights risk to persons 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.
SUPERVISOR'S NAME:Kimberly Williams
LICENSING EVALUATOR NAME:Rachel Zeron
LICENSING EVALUATOR SIGNATURE:
DATE: 04/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/20/2022


LIC809 (FAS) - (06/04)
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