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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600636
Report Date: 06/02/2023
Date Signed: 06/02/2023 11:39:34 AM

Document Has Been Signed on 06/02/2023 11:39 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: 10DATE:
06/02/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jessica DornTIME COMPLETED:
11:45 AM
NARRATIVE
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On June 2, 2023, at 9:00am Licensing Program Analysts (LPA), Adrian Castellon and Amber Hopkins, conducted an unannounced Case Management Inspection due to an incident with child #1. On 05/25/2023, the Department received the incident report from the facility for child #1. The facility submitted an Unusual Incident Report via email to our Agency on 05/31/2023.

During today's case management inspection, LPA met with director Jessica Dorn and facility staff members Alex Gonzales and Eliza Rodriguez. Present during today's inspection were ten children in care.

The facility self reported on 5/25/2023 that child #1 got finger got pinched as a staff member closed the door. Child, 18 months, was on the playground when staff member opened door from the inside and child's finger was pinched in the door jamb as door was closed. LPA interviewed director and two teachers regarding the incident. Mother was notified of the incident at time of pick up which was within 40 to 60 minutes of the incident occurring. Per interviews conducted, required 100% visual supervision was not provided which resulted in injury. Also per interviews conducted, first aid was not applied.

Incident was reported in a timely manner to the licensing office.

Also during this inspection, a recent Hand Foot and Mouth outbreak was discussed. Director has properly reported to the licensing office and to parents. Director has also reported to County Health office.


Two type B deficiencies were issued during today's visit. LPA conducted an exit interview with the licensee. Appeal rights were given and discussed with director.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Adrian Castellon
LICENSING EVALUATOR SIGNATURE: DATE: 06/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/02/2023
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 06/02/2023 11:39 AM - It Cannot Be Edited


Created By: Adrian Castellon On 06/02/2023 at 10:49 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
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: CHILDTIME CHILDREN'S CENTER - CHULA VISTA
FACILITY NUMBER: 376600636

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/09/2023
Section Cited
CCR
101229(a)(1)

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101229 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, except as specified i n Sections
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Director must submit a written plan detailing staff positioning and supervision plan to ensure required supervision is provided. Director will hold a staff meeting and review supervision regulation.
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101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement was not met as evidence by child being injured due to a lack of required supervision. This could pose a threat to the health and safety of children in care.
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Type B
06/02/2023
Section Cited
CCR101223(a)(2)

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101223 Personal Rights: 101223 Personal Rights (a)The licensee shall ensure that each child is accorded the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.

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Director must submit a written plan detailing who will apply first aid and when it will be applied. Director will hold a staff meeting and review personal rights regulation
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This requirement was not met as evidence by child being injured and not receiving first aid. This could pose a threat to the health and safety of children 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:Cynthia Gray
LICENSING EVALUATOR NAME:Adrian Castellon
LICENSING EVALUATOR SIGNATURE:
DATE: 06/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/02/2023


LIC809 (FAS) - (06/04)
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