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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 313605618
Report Date: 05/27/2021
Date Signed: 05/27/2021 10:57:07 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/08/2021 and conducted by Evaluator Katrina Owens
COMPLAINT CONTROL NUMBER: 03-CC-20210408162020
FACILITY NAME:CHILDTIME CHILDREN'S CENTERFACILITY NUMBER:
313605618
ADMINISTRATOR:SHATARA, CRYSTALFACILITY TYPE:
840
ADDRESS:1267 PLEASANT GROVE BLVD.TELEPHONE:
(916) 783-0443
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY:28CENSUS: 0DATE:
05/27/2021
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Hanna Adams- Assistant DirectorTIME COMPLETED:
11:15 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
LACK OF SUPERVISION; Child was left unsupervised on the playground.
PERSONAL RIGHTS: Child did not receive assistance during choking incident.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
An unannounced telephone call was made by Licensing Program Analyst Owens due to COVID-19. LPA Owens spoke with Assistant Director, Hanna Adams. The purpose of the telephone call is to close a complaint investigation that was originally opened on April 19, 2021.
Based upon the interviews conducted, there was not a preponderance of evidence to support the above allegations or incident occurred therefore, this complainant is unsubstantiated. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the allegations did or did not occur.

An exit interview was conducted. Appeal rights were emailed and explained to the licensee.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Katrina OwensTELEPHONE: 916-263-6280
LICENSING EVALUATOR SIGNATURE:

DATE: 05/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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