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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408291
Report Date: 08/30/2021
Date Signed: 08/30/2021 02:40:49 PM

Document Has Been Signed on 08/30/2021 02:40 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:KID TIME, INCFACILITY NUMBER:
073408291
ADMINISTRATOR:FARRELL, STRETTAFACILITY TYPE:
850
ADDRESS:2491 SAN MIGUEL DR.TELEPHONE:
(925) 987-6713
CITY:WALNUT CREEKSTATE: CAZIP CODE:
94596
CAPACITY: 45TOTAL ENROLLED CHILDREN: 0CENSUS: 43DATE:
08/30/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Director, Streeta FarrellTIME COMPLETED:
12:00 PM
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On 8/30/21 at 10:00 AM Licensing Program Analysts (LPAs) Monica Mathur and Michelle Sutton conducted an unannounced Annual inspection at Kid Time, Inc located in the grounds of St. Lukes Church. LPAs met with Director, Streeta Farrell and explained the purpose of today's inspection. LPAs were granted the inspection authority to enter the facility. Facility's operating days and hours are Monday to Friday 7 AM to 6 PM in 3 Rooms - Pizza Pups, Ruff Dogs, Lunchies. At 10:05 AM the physical plant was inspected. LPAs toured the premises with the Director.
Indoor space: Facility was observed to be in compliance with teacher to children ratio requirement during LPAs' inspection.
Ratios during today’s inspection:
Room Lunchies: 18 kids, 2 staff
Rooms Pizza Pups and Ruff Dogs were outside playing with 24 kids and 5 staff.
The classrooms, restrooms, food storage areas and spaces accessible to children were inspected. Disinfectants, cleaning solutions, poisons and other items that are dangerous to the health and safety of children were stored in places inaccessible to them. Storage areas for poisons were locked and medications were kept in a safe place inaccessible to children. Cabinets, drawers, and rooms used for storage were locked. Furniture and equipment were age appropriate and in good condition, free of sharp, loose, or pointed parts. Restrooms for children were observed to be in safe, sanitary, and functioning condition. Floors were clean and free from tripping hazard. Foods and beverages were stored safely. Food storage area were clean, free of litter, rubbish, and rodents/vermin. Trash cans for solid waste had tight-fitting covers on and were in good repair. Director stated that facility does not possess nor store any weapons on the premises. LPA observed a Fire extinguisher, Smoke and Carbon Monoxide Detectors. All materials and surfaces accessible to children appeared to be toxic free. Menus were observed to be posted at least 1 week in advance in a place visible by the child’s authorized representative, dated and kept on file for 30 days and made available upon request. CONTINUED.....
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE: DATE: 08/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2021
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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: KID TIME, INC
FACILITY NUMBER: 073408291
VISIT DATE: 08/30/2021
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Outdoor Space: At 10:25 AM Outdoor playground was inspected and observed to be fenced and safe. The play equipment was maintained in good condition and free of hazards. Surface of the outdoor activity space was in safe condition and free of hazards. Areas around and under high climbing equipment and slides were cushioned with material that absorbs falls (tan bark, hay). There were no bodies of water observed. Drinking water is arranged to be readily available to children during indoor and outdoor activities. Play ground is on a slope and Director was reminded that visual supervision is important due to the terrain especially when children are on the swings.

File Review: At 10:30 AM Children sign in and out procedures and logs were reviewed. All children were signed in by their authorized representative with full legal signatures. A sample of 10 Children's files and 9 Staff files was taken for review.
Child files contained LIC700 Information and Emergency Forms and Medical Assessments – Physician’s Report LIC701, Child’s Preadmission Health History - Parent Report LIC702 and immunization record.
Staff files contained their Personnel Record LIC501 with Health Screening, immunizations and current Mandated Reporter Training. There was at least one staff present with current certification in Pediatric CPR and First Aid at the facility during inspection. Children's Roster and Personnel Report was reviewed, and a copy obtained.

Director was reminded about ensuring that each child is accorded their personal rights. LPA informed Director that the Department shall notify the licensee to immediately terminate the employment of or to remove/bar any person with specified convictions or for other reasons. The licensee shall comply with the notice. LPA reminded Director of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license, and who come in contact with or provide care and supervision to the children. For an initial violation, civil penalty amounts to $100.00 per person per day with a maximum of $500.00 per person. For a subsequent violation within a 12-month period, civil penalty amounts to $100.00 per person per day with a maximum of $3000.00 per person.

LPA reminded Director about violations that would result in an immediate assessment of civil penalty in the amount of $500. Director is encouraged to visit the Department’s website at www.cdss.ca.gov to access resources for Providers, Title 22 Regulations, Online option to pay Annual License fee, Adoption of new Laws, etc.
CONTINUED....
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021
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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME: KID TIME, INC
FACILITY NUMBER: 073408291
VISIT DATE: 08/30/2021
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Director stated Center is registered to receive CCLD updates.

For information on Guardian Background Check, visit website:
www.guardian.dss.ca.gov

In the areas that were evaluated, no regulatory violations were observed. Exit Interview was conducted with Director, where this report was reviewed and discussed. Report was signed by the Director confirming receipt of documents. Appeal rights were provided.

A NOTICE OF SITE VISIT WAS ISSUED, AND MUST BE POSTED ON OR ADJACENT TO THE INTERIOR SIDE OF THE MAIN DOOR INTO THE FACILITY FOR 30 CONSECUTIVE DAYS.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021
LIC809 (FAS) - (06/04)
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