153808447-7-12-2019-04-CC-JTHN-BDZQRY-20190712122444

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 153808447
Report Date: 07/12/2019
Date Signed: 07/12/2019 12:24:49 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	A GOOD TIME OUT		FACILITY NUMBER:	153808447
ADMINISTRATOR:	MELANIE SHERMAN		FACILITY TYPE:	830
ADDRESS:	3400 CALLOWAY DRIVE, SUITE 502		TELEPHONE:	(661) 410-8463
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93312
CAPACITY:	17	CENSUS: 9	DATE:	07/12/2019
TYPE OF VISIT:	Annual/Random	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Karen Kiser- Director		TIME COMPLETED:	12:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Jessika Thompson conducted an unannounced annual/random visit. LPA met with Director Karen Kiser, who provided a tour of facility, inside and outside, as shown on the facility sketch. There are no bodies of water, firearms and/or ammunition on the premises. Disinfectants, hazardous items and medications are inaccessible to children. Storage area for poisons is locked and medications are inaccessible to children. Furniture, equipment and materials are sufficient, age appropriate, in good repair and toxic free. The playground equipment and outdoor activity space is maintained and in good condition, free of hazards with adequate cushioning material. Rooms and floors are safe and clean. Food preparation area is clean and free of rodent and other vermin. Contaminated food is discarded immediately, when applicable. Storage containers for solid waste are in good repair with tight-fitting covers. Conditions, limitations and capacity specified on license are in compliance. Staff requiring criminal record clearance or exemptions are associated to the facility as indicated on LIS 555 – Facility Roster. First Aid/CPR reviewed and in compliance. A sample of children's and staff’s records reviewed. Children’s records include required proof of immunization, consent for emergency medical treatment and Infant Needs and Services information. Staff records contain required health screening, documentation of infant qualifications, child abuse mandated reporter certification and proof of immunization. Staff provide direct supervision and are in compliance with required ratios. There is sufficient infant napping equipment. Infant indoor and outdoor activity space is separate from other components of the facility. Lead safety was discussed, and LPA provided Director Kiser with a brochure. Director Kiser understands that lead safety information must also be provided to parents and/or authorized representatives of children in care. Safe sleep concepts were discussed and LPA provided Director Kiser with a handout. Licensee is aware that forms and updated information may be obtained on the CCLD website (www.ccld.ca.gov). This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and, equipment/supplies, and reviewed children’s, personnel, and administrative records. (Continued on LIC809- C)

SUPERVISOR'S NAME: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika Thompson	TELEPHONE: 559-341-4622
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2019

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: A GOOD TIME OUT	FACILITY NUMBER: 153808447
	VISIT DATE: 07/12/2019

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For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

Per California Code of Regulations, Title 22, Division 12, no deficiencies were observed today.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS

SUPERVISOR'S NAME: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika Thompson	TELEPHONE: 559-341-4622
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2019

LIC809 (FAS) - (06/04)

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