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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600636
Report Date: 12/07/2022
Date Signed: 12/08/2022 10:54:23 AM

Document Has Been Signed on 12/08/2022 10:54 AM - 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:CHILDTIME CHILDREN'S CENTER - CHULA VISTAFACILITY NUMBER:
376600636
ADMINISTRATOR:JESSICA DORNFACILITY TYPE:
850
ADDRESS:770 RANCHO DEL REY PARKWAYTELEPHONE:
(619) 397-0165
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY: 129TOTAL ENROLLED CHILDREN: 129CENSUS: DATE:
12/07/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Jessica DornTIME COMPLETED:
01:45 PM
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On 12/07/22 at 11:30am Licensing Program Analyst (LPA) Adrian Castellon conducted an unannounced inspection to follow up on a self reported incident that occurred on 10/19/2020. Child in care received a small cut on his forehead while playing under the play structure located on the preschool playground, LPA Castellon met with Director Jessica Dorn and discussed the purpose of the inspection.

LPA examined the area and structure where incident occurred. The structure is in good condition and free of sharp edges or points. On day of incident there were eighteen (18) children in care and three (3) staff members out on the playground. LPA Castellon interviewed the three staff members present, parent of child involved in the incident, and spoke to child with parent's assistance. Staff observed child go under the play structure and come out from under the structure with a small cut on his forehead. Staff applied first aid. Cut was cleaned and ice was applied. Parent was advised immediately at the time the incident happened via Sprout App and telephone call. Parent took child to emergency room where a band aid was placed on child's forehead. Child did not receive stitches.

It appears this is an isolated incident. Supervision was in place, ratios were met and staff responded appropriately. The facility met reporting requirements with licensing office and parent. The child returned back to facility after missing one day of school.

No deficiencies are cited. Provided Notice of Site Visit (LIC 9213). Exit interview conducted.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Adrian Castellon
LICENSING EVALUATOR SIGNATURE: DATE: 12/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/07/2022
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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