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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073408893
Report Date: 11/29/2022
Date Signed: 11/29/2022 05:43:32 PM

Document Has Been Signed on 11/29/2022 05:43 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:
073408893
ADMINISTRATOR:HODES, CHARLESFACILITY TYPE:
840
ADDRESS:1942 LINDA DRIVETELEPHONE:
(925) 503-6320
CITY:PLEASANT HILLSTATE: CAZIP CODE:
94523
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 24DATE:
11/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Charles Hodes and Leah Rosenthal- KambicTIME COMPLETED:
05:50 PM
NARRATIVE
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On 11/29/22 at 11:20am Licensing Program Analyst (LPA) Catherine Fernandes met with Director Charles Hodes for an Unannounced Required Annual Inspection. Later in the visit owner Leah Rosenthal arrived. There were 24 school age children in care and an additional two fingerprint cleared staff members. The teacher/ child ratio was being met today. The center was toured for a health and safety inspection. The center has preschool component on site, license number 73408923. The facility operates the from 7:00am – 6:00pm Monday through Friday.

The school age children have one main classroom and when the preschool children leave an additional classroom is available. The entire upstairs of the building is off limit to the children in care. The heating and lighting and ventilation is adequate. There are a total of two toilets and two sinks available for the children which are sanitary and in operational conditions. There is a separate bathroom upstairs for staff. The outside play area is the fully fenced with a shaded areas for the children. There is a small climbing dome that has foam cushioning to absorb the impact from a fall. There are supplies available for the children to wash and dry their hands. LPA did not observe any bodies of water, free standing water, or toxic items accessible to children during todays inspection. The center provides snacks to the children while in care. There an available filtered water machine indoors, in addition to the children having their own water bottles and when the children are outdoors water is provided. The children have their own hooks to store belongings.


There is a working carbon monoxide in the school age classroom, a fully charged 2A10BC fire extinguisher and the fire system is hardwired. All proper postings are made visible by the front entrance of the center. The center has electronic sign-in and out for the children. LPA reviewed five children’s files and all four staff files.

REPORT cont on 809C.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE: DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/29/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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Document Has Been Signed on 11/29/2022 05:43 PM - It Cannot Be Edited


Created By: Catherine Fernandes On 11/29/2022 at 04:17 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: 073408893

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/29/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101174(d)(2)
Disaster and Mass Casualty Plan
(d) Disaster drills shall be conducted at least every six months. (2) The drills shall be documented. This documentation shall be kept in the child care center for at least one year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, the licensee did not comply with the section cited above there are no written logs which poses a potential safety risk to persons in care.
POC Due Date: 12/20/2022
Plan of Correction
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Center will conduct a drill and document the drill then send a picture copy to CCLD
Type B
Section Cited
CCR
101238(a)
Buildings and Grounds
(a) The child care center shall be clean, safe, sanitary and in good repair at all times to ensure the safety and well-being of children, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above there are items in the center that need repair which poses safety risk to persons in care.
POC Due Date: 12/20/2022
Plan of Correction
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The center will add sand to the sandbox, get the outside wall repaired, get door handle and get rid of items that can not be repaired, then send pictures to CCLD.
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:Mayla Mendoza
LICENSING EVALUATOR NAME:Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:
DATE: 11/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 11/29/2022 05:43 PM - It Cannot Be Edited


Created By: Catherine Fernandes On 11/29/2022 at 04:17 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: 073408893

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/29/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101238(d)
Buildings and Grounds
(d) General permanent or portable storage space shall be available for the storage of the center's equipment and supplies.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations, the licensee did not comply with the section cited above there are items being stored in walkways which poses a safety rights risk to persons in care.
POC Due Date: 12/20/2022
Plan of Correction
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The center will organize and ensure there is no clutter in the classrooms or walkways, then send pictures to CCLD.
Type B
Section Cited
HSC
1596.7995(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in three out of four staff members did not have complete immunization's which poses a potential health risk to persons in care.
POC Due Date: 12/20/2022
Plan of Correction
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All staff members will obtain immunization and send a summary of completion to CCLD.
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:Mayla Mendoza
LICENSING EVALUATOR NAME:Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:
DATE: 11/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2022


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Document Has Been Signed on 11/29/2022 05:43 PM - It Cannot Be Edited


Created By: Catherine Fernandes On 11/29/2022 at 04:17 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: 073408893

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/29/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
101226(e)(3)(B)
Health-Related Services
(3) Prescription medications may be administered if all of the following conditions are met: (B) For each prescription medication, the licensee shall obtain, in writing, approval and instructions from the child's authorized representative for the administration of the medication to the child.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above there were no documentation for a child's medication which poses a potential health and safety risk to persons in care.
POC Due Date: 12/20/2022
Plan of Correction
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Center will fill out form LIC9221 or come up with a form that covers all areas of CCLD's form, then send a copy to CCLD.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Mayla Mendoza
LICENSING EVALUATOR NAME:Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:
DATE: 11/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2022


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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: 073408893
VISIT DATE: 11/29/2022
NARRATIVE
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During the inspection LPA Fernandes observed the following deficiencies:
- a broken basketball hoop, some of the outdoor are walls had a small section missing, and there is a screen that was partially pulled off.
- a review of medication, a child had medication on site without proper documentation.
- a walk through area had large bag of cornstarch, pressure washer and a bicycle.
- three out four staff members did not have completed immunization.
- no written documentation of disaster drills.
Director was reminded that EMSA approved Pediatric CPR & First Aid training must be completed every two (2) years. Personnel Roster must be properly maintained, and fire/disaster drill must be conducted every six (6) months and documented. Director was reminded that California Law requires all facilities to report unusual incidents or injuries to children in care, to child's parents, and to the Department of Social Services using the Unusual Incident/Injury form (LIC 624). Incidents must be reported within 24 hours by phone, fax, or email. LPA informed Director that all forms can be downloaded at www.ccld.ca.gov. Director was also informed that Mandated Reporter Training ("General" and "Child Care Providers") is required for all staff and is to be renewed every 2 years by visiting www.mandatedreporterca.com.
This facility provides Incidental Medical Services – IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

Director was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

REPORT CONT. ON 809C

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022
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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: 073408893
VISIT DATE: 11/29/2022
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To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Director and owner

Report, Appeal Rights and notice of site visit provided.

SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Catherine Fernandes
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022
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