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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343605615
Report Date: 10/28/2021
Date Signed: 10/28/2021 02:54:07 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:CHILDTIME CHILDREN'S CENTERFACILITY NUMBER:
343605615
ADMINISTRATOR:TRACI MOTEFACILITY TYPE:
840
ADDRESS:2555 MILLCREEK DRIVETELEPHONE:
(916) 648-1061
CITY:SACRAMENTOSTATE: CAZIP CODE:
95833
CAPACITY:28CENSUS: 0DATE:
10/28/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Artastia Bolar- Assistant DirectorTIME COMPLETED:
03:00 PM
NARRATIVE
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On Thursday, October 28th, 2021, at 1:50pm, Licensing Program Analyst (LPA) Blake Morillas conducted an unannounced Case Management visit in regards to a Self Reported Unusual Incident Report (UIR). LPA informed the Assistant Director, Artastia Bolar, of the reason for the visit. Upon arrival there were no school age children present.

The Director self reported an incident on 10-27-2021, where the day before (10-26-2021) a child had fallen asleep and was inadvertently left in the parked bus at the facility. Approximately a half an hour had passed before the child was discovered by a parent.

At 2:36pm, interviews regarding the incident were conducted as well as a tour of the bus where the incident took place.

Even though the incident was self reported, due to an absence of supervision, the facility is cited with a Zero Tolerance Type A violation and a Civil penalty is being assessed. Deficiencies are cited on the subsequent page of this report (LIC 809-D) under the California Code of Regulations, Title 22.

At 2:24pm, the report was reviewed with the Assistant Director and an exit interview was conducted.

Notice of site visit posted.

SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Blake MorillasTELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: CHILDTIME CHILDREN'S CENTER
FACILITY NUMBER: 343605615
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/28/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/29/2021
Section Cited

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101229 Responsibility for Providing Care and Supervision: (a)(1)No child(ren) shall be left without the supervision of a teacher at any time. . .
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This requirement was not met due to a self reported incident where a child had been left in a parked bus for approximately 30 minutes until being discovered by a parent. This is a Zero Tolerance issue. An immediate Civil Penalty of $500 is being assessed.
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The Director/Assistant Director will provide a copy of the training materials as well as certificate of completion of the re-training.

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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: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Blake MorillasTELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:
DATE: 10/28/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/28/2021
LIC809 (FAS) - (06/04)
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