300610695-10-24-2022-06-CC-PRIS-CKHR6Y-20221024124532

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300610695
Report Date: 10/24/2022
Date Signed: 10/24/2022 12:47:05 PM

Document Has Been Signed on 10/24/2022 12:47 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME:	CHILDTIME LEARNING CENTER		FACILITY NUMBER:	300610695
ADMINISTRATOR:	SILVA, ANDREA		FACILITY TYPE:	850
ADDRESS:	13881 PROSPECT AVE		TELEPHONE:	(714) 544-6820
CITY:	SANTA ANA	STATE: CA	ZIP CODE:	92705
CAPACITY:	103	CENSUS: 67	DATE:	10/24/2022
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Andrea Silva, Director		TIME COMPLETED:	01:15 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) P. Rivas conducted a case management inspection to follow up on a self-report unusual incident that was submitted to CCL Regional Licensing Office on 10/12/22. It was reported by Director Andrea Silva that on 10/07/22 Staff #1 left Child #1 unattended for approximately 15-20 seconds but Staff #1 did not advise Director until 10/11/22. C1's parents emailed Director on 10/09/22. Ms. Silva stated the following: Staff #1 notified the director that she found the child in the classroom by himself/herslef crouched down next to a book shelf. Director reported that staff#1 had completed a count when transitioning from classroom to outside at approximately 5:30pm. While outside S1 was conducting the name to face procedure as staff was receiving additional children and noted C1 missing. Director reported that is when S1 went back into classroom and found C1 by himself/herself. Director reports that the classroom video footage was reviewed by the District Manager, Deanne McCashland and confirmed child was left in the classroom for approximately 10-15 seconds and was seen crouched down by the book shelf. Staff #1 stated s/he did miscount the number of children when transitioning and did not follow the face to name procedure. S1 reported s/he heard crying and went back into the classroom through the second door and found C1 alone crouching besides bookshelves. S1 further reported s/he was the closing teacher and Director had gone for the day and did not advise her until the next business day was 10/11/22 Review of files show S1 has been trained in policies and procedures, classroom has been reconfigured(bookshelves moved). LPA was unable to review the video footage as it is kept at the district office; however, the District Manager did review the video and confirmed child was left in the classroom alone. page 1

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat Rivas	TELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2022

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 10/24/2022 12:47 PM - 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: CHILDTIME LEARNING CENTER	FACILITY NUMBER: 300610695
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/24/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 10/25/2022 Section Cited	1 2 3 4 5 6 7	101229(a)(1) Responsibility for Providing care and Supervision. (a) The licensee shall provide care and supervision....(1) No child(ren) shall be left without the supervision of a teacher at any time...Supervision shall include visual observation. Requirement is not met as evidenced by;
	8 9 10 11 12 13 14	Based on interviews , the facility staff failed to provide supervision, as Staff #1 found child #1 alone in the classroom. This poses an immediate risk to the health and safety of the children in care.	8 9 10 11 12 13 14	received and reviewed the protocal reminder by due date of 10/25/22.
	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: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat Rivas	TELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2022

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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868

FACILITY NAME: CHILDTIME LEARNING CENTER	FACILITY NUMBER: 300610695
	VISIT DATE: 10/24/2022

NARRATIVE

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Based on LPA’s interviews conducted with staff and video footage, the following deficiency is being cited in accordance with California Code of Regulations, Title 22, Division 12, Section 101229(a)(1) Responsibility for Providing Care and Supervision. The deficiency is being cited on the attached 809D.

If the facility receives a Type 'A' violation the licensee shall post and provide copies of the report to parents/guardians of the children in care at the facility by the next business day and shall provide to the parents/guardians of children newly enrolled at the facility during the next 12 months. In addition, the licensee shall immediately post upon receipt the Proof of Correction for 30 consecutive days. The licensee is to keep Acknowledgement Receipt (LIC9224) signed by parents in each child’s file.

An exit interview was completed. The report was reviewed and discussed. Appeal Rights were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the licensing office within 15 business days. The facility representative was informed that the 'Notice of Site Visit' must be posted for 30 consecutive days. Failure to post will result in civil penalties of $100.00. The 'Notice of Site Visit' must be posted on or adjacent to the door. Failure to post Type A Reports for 30 days will result in a civil penalty of $100.00.

SUPERVISOR'S NAME: Rina Lopez	TELEPHONE: (714) 703-2808
LICENSING EVALUATOR NAME: Pat Rivas	TELEPHONE: 714-703-2800
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2022

LIC809 (FAS) - (06/04)

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