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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304370508
Report Date: 10/23/2024
Date Signed: 10/23/2024 03:46:23 PM


Document Has Been Signed on 10/23/2024 03:46 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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868



FACILITY NAME:CHILDTIMEFACILITY NUMBER:
304370508
ADMINISTRATOR:LOPEZ, AMERICAFACILITY TYPE:
830
ADDRESS:2839 VILLA REAL DRIVETELEPHONE:
(714) 637-2022
CITY:ORANGESTATE: CAZIP CODE:
92867
CAPACITY:28CENSUS: 18DATE:
10/23/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Director-America LopezTIME COMPLETED:
04:00 PM
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On 10/23/2024 at 1:40PM Licensing Program Analyst (LPA) Karen Navar conducted an unannounced case management incident inspection in response to a self-reported Unusual Incident dated 10/17/2024. LPA met with Team Lead Melanie Superville. LPA observed 6 infants with 2 staff members and toddlers had 12 infants with 2 staff members during nap time. At 2:05PM LPA then met with Director America Lopez who continued the inspection.

A review of staff criminal clearance records on this date indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

On 10/17/2024 a self-reported Unusual Incident Report (UIR) was filed with the Licensing Office. The facility reported on 10/17/2024, Teacher S1 fed a cereal jar with breast milk to C1 that belong to C2. Staff S2 stated that the jar of cereal with breast milk belonged to C2. Staff stated that C3 accepted the jar of cereal jar with breast milk at drop off time without a label and that the jar was placed in C1’s bin and because of not having a label they assumed it belonged to C1.

During staff interviews on 10/23/2024, staff S3 and S4 stated that at morning drop off parents are to label food items with child’s name that are brought from home and then the staff will place the item in the bin with child's name in the refrigerator. LPA was informed by S4 that after investigation with staff cereal jar tipped over into other child's tray. LPA observed extra labels for parents if needed on the shelf next to cubbies. LPA observed and took photo of 1 food item “Organic Strawberry Rice Rusks” in C3's bin that was not labeled as this is an immediate risk to the health, safety, or personal rights of children in care. LPA printed and reviewed Title 22 Regulation 101427(j) Infant Care Food Service with Director America Lopez

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SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 795-0415
LICENSING EVALUATOR NAME: Karen NavarTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:
DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/23/2024
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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME: CHILDTIME
FACILITY NUMBER: 304370508
VISIT DATE: 10/23/2024
NARRATIVE
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Based on the information gathered from the self-reported unusual incident report, observations, and interviews with two staff members, it was determined that infant C1 was fed C2’s jar of cereal with breast milk due to not being labeled. California Code of Regulations, Title 22, Section 101427(j) Infant Care Food Service (j)Bottles, dishes, and containers of food brought by the infant's authorized representative shall be labeled with the infant's name and the current date.

LPA Navar informed Director America Lopez that this report dated 10/23/2024 documents one Type A citation which shall be posted for 30 consecutive days as there is/are immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Navar informed the Director America Lopez to provide a copy of this licensing report dated 10/23/2024 that documents any Type A citation to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with the Director America Lopez. Notice of site visit was given and must remain posted for 30 days. Failure to comply with the posting requirements shall result in an immediate civil penalty of $100.



Appeal Rights and deficiencies were discussed. The Director was provided a copy of their appeal rights (LIC 9058) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Regional Office within 15 business days.

End of Report

SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 795-0415
LICENSING EVALUATOR NAME: Karen NavarTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/23/2024 03:46 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
ORANGE CO CHILD CARE, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868


FACILITY NAME: CHILDTIME
FACILITY NUMBER: 304370508

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/23/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/23/2024
Section Cited
CCR
101427(j)

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101427 Infant Care Food Service (j) Bottles, dishes, and containers of food brought by the infant's authorized representative shall be labeled with the infant's name and the current date.
This requirement is not met as evidenced by:
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DIrector reviewed policy regarding labeling all food items. Opening staff receiveing food items that everything is labeled. An agreement letter was sent out to all parents acknowleding all items will be labeled at dorp off with their child.
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Based on self-reported unusual incident report, observations, interviews with two staff members, it was determined that C1 was fed C2’s jar of cereal with breast milk due to not being labeled as there is an immediate risk to the health, safety, or personal rights 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: Judy HansonTELEPHONE: (714) 795-0415
LICENSING EVALUATOR NAME: Karen NavarTELEPHONE: (714) 703-2800
LICENSING EVALUATOR SIGNATURE:
DATE: 10/23/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/23/2024
LIC809 (FAS) - (06/04)
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