191801302-2-3-2023-54-CC-DCHS-CNPQFW-20230203110837

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191801302
Report Date: 02/03/2023
Date Signed: 02/03/2023 11:08:44 AM

Document Has Been Signed on 02/03/2023 11:08 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, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME:	CHILDTIME CHILDRENS'S CENTER		FACILITY NUMBER:	191801302
ADMINISTRATOR:	ANA FRAGOSO-TOVALIN		FACILITY TYPE:	830
ADDRESS:	4820 S. EASTERN AVE. SUITE #F		TELEPHONE:	(323) 721-0552
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90040
CAPACITY:	24	CENSUS: 11	DATE:	02/03/2023
TYPE OF VISIT:	Case Management - Deficiencies	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Ana Fragoso Tovalin, Director		TIME COMPLETED:	11:30 AM

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	On February 3, 2023 at 10:00am, Licensing Program Analyst (LPA) Dayna Chambers conducted an unannounced complaint inspection to the above facility for the purpose of delivering findings for the allegations above. LPA met with Fragoso-Tovalin, Director. At the time of arrival there were 11 children present with 2 staff and Director; at the same time another staff member was rotating into the classroom to relieve Director. During the course of a complaint investigation dated 11/04/222, LPA obtained additional information regarding violations for infant safe sleep regulations. LPA obtained photos and conducted interviews with parents and staff. Witness Observations and photos revealed on more than one occasion in October 2022 and November 2022, Child #1 and Child #2 were allowed to sleep on the floor in an unsafe position on a donut shaped pillow on the floor in the infant room. Photo #1 depicts Child #1 an infant sleeping on the donut pillow with the head tilted forward. Photo #2 depicts child #2 asleep on donut pillow on the floor, sleeping on their face. The children were not transferred to the crib in a timely manner after falling asleep thus not following infant safe sleep regulations. The preponderance of the evidence standard has been met. Therefore, the above allegation is found to be Substantiated. California Code of Regulations (CCR), Title 22-Infant Care Activities -101430(a)(3)(E) is being cited on the attached LIC 9099-D. A copy of this report shall be provided to the parent/guardian of children currently enrolled by the next business day or immediately upon return. A copy of this report shall also be provided to the parent/guardian of any newly enrolled children for the next 12 months (1 year). Acknowledgement of Receipt (LIC 9224 form) must be maintained in each child’s file immediately upon receipt from parent. Licensee was provided with a copy of the Acknowledgement of Receipt of Licensing Reports (LIC 9224) Form during this visit. Continued 1 of 2

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Dayna Chambers	TELEPHONE: (323) 558-2962
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CHILDTIME CHILDRENS'S CENTER	FACILITY NUMBER: 191801302
	VISIT DATE: 02/03/2023

NARRATIVE

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of Licensing Reports (LIC 9224) Form during this visit.

The Notice of Site Visit (LIC 9213) must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

Exit interview conducted and report was reviewed with the Director, Ana Fragoso Tovalin during which appeal rights were given and explained. A copy of the Appeal Rights was provided. The Licensee’s signature on this report acknowledges receipt of rights.

SUPERVISOR'S NAME: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Dayna Chambers	TELEPHONE: (323) 558-2962
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/03/2023 11:08 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754

FACILITY NAME: CHILDTIME CHILDRENS'S CENTER	FACILITY NUMBER: 191801302
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/03/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 02/13/2023 Section Cited	1 2 3 4 5 6 7	101430(a)(3)(E If the infant falls asleep before being placed in a crib, staff shall move the infant to a crib as soon as possible as required by 101430(a)(3)(E This requirement is not met as evidenced by: Based on LPA Interviews and Photos: During October and November 2022Child #1 and Child #2 were allowed to ,	1 2 3 4 5 6 7	Director and Staff will not allow children to sleep on the floor and remove the donut shaped pillow. LPA to obtain signed declaration that children will not sleep on the floor and be moved to equipment for napping. Infant Safe Sleep training for staff - sign log with name, date of attendance and type of topics covered for safe sleep.
	8 9 10 11 12 13 14	sleep on the floor in an unsafe position on a donut shaped pillow on the floor in the infant room. Photo #1 depicts Child #1 an infant sleeping on the donut pillow with the head tilted forward. Photo #2 depicts child #2 asleep on donut pillow on the floor, sleeping on their face. The children were not transferred to the crib in a timely manner after falling asleep thus not following infant safe sleep regulations. Which poses an immediate Health, Safety, or Personal Rights Risk to children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Valarie Cook	TELEPHONE: (323) 513-3858
LICENSING EVALUATOR NAME: Dayna Chambers	TELEPHONE: (323) 558-2962
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023

LIC809 (FAS) - (06/04)

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