<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408291
Report Date: 09/07/2023
Date Signed: 09/07/2023 01:44:21 PM

Document Has Been Signed on 09/07/2023 01:44 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: 45CENSUS: 42DATE:
09/07/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Streeta FarrellTIME COMPLETED:
02:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 9/7/23 Licensing Program Analyst (LPA) Monica Mathur conducted an unannounced Case Management inspection and Kid Time Inc and met with Director, Streeta Farrell.

As a result of investigation and inspection, in July 2023 there was a rat infestation that facility failed to report to Licensing Department. Technical Violations (Advisory Notes) were also issued for Supervision and Personal Rights of children in care.

Exit interview was conducted with Director, Streeta Farrell. A NOTICE OF SITE VISIT WAS ISSUED, MUST BE POSTED FOR 30 DAYS.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE: DATE: 09/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 09/07/2023 01:44 PM - It Cannot Be Edited


Created By: Monica Mathur On 09/07/2023 at 12:40 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612

FACILITY NAME: KID TIME, INC
FACILITY NUMBER: 073408291

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/14/2023
Section Cited
CCR
101212(d)(1)

1
2
3
4
5
6
7
101212 Reporting Requirements (d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event.
1
2
3
4
5
6
7
By POC Due Date Director agreed to submit a written plan on their understanding of regulation and how they will stay in compliance.
8
9
10
11
12
13
14
Per investigation, facility failed to report rodent infestation to Licensing Department. This poses a potential risk to health/safety of children in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Sherelle Johnson
LICENSING EVALUATOR NAME:Monica Mathur
LICENSING EVALUATOR SIGNATURE:
DATE: 09/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/07/2023


LIC809 (FAS) - (06/04)
Page: 2 of 2