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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300611703
Report Date: 12/01/2021
Date Signed: 12/01/2021 11:55:06 AM

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 CHILDREN'S CENTER INC.FACILITY NUMBER:
300611703
ADMINISTRATOR:COURTNEY, JOELLEFACILITY TYPE:
830
ADDRESS:4876 IRVINE CENTER DRIVETELEPHONE:
(949) 551-4533
CITY:IRVINESTATE: CAZIP CODE:
92604
CAPACITY:28CENSUS: 19DATE:
12/01/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Director Joelle CourtneyTIME COMPLETED:
12:15 PM
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On 12/01/2021, a Case Management Inspection was conducted at the facility by Licensing Program Analyst (LPA) Tina Nguyen. The facility file was reviewed prior to this inspection being conducted.

LPA Nguyen met with Director Joelle Courtney. During the inspection the facility had 6 staff members and 19 children present. A review of staff records indicates all facility staff or individuals who require caregiver background checks have received a criminal record clearances or exemptions and a child abuse index clearance.

The inspection was conducted in response to an Unusual Incident Report received on 11/09/2021, in which a parent #1 (See Confidential Names List LIC811) had reported to staff #1 potentially handle a child, child #1, roughly. Staff #2 then reported the incident to Licensing in a timely fashion, compliant with reporting requirement regulations. An inspection was conducted today, 12/01/2021, to investigate into this unusual incident. During the course of the investigation staff and child related to the reported unusual incident were interviewed, a physical plant inspection was conducted, and census of children was taken. Based on interviews and the information gathered for this incident investigation, there was not enough evidence to determine if there was a personal rights violation. No violations were issued during today's visit, as a result of this reported unusual incident.

The facility was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. The Notice of Site Visit was posted. 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.
SUPERVISOR'S NAME: Thuy HoTELEPHONE: (714) 287-8515
LICENSING EVALUATOR NAME: Tina NguyenTELEPHONE: (714) 292-2922
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2021
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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