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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 073408918
Report Date: 05/09/2022
Date Signed: 05/09/2022 02:32:55 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/04/2022 and conducted by Evaluator Monica Mathur
PUBLIC
COMPLAINT CONTROL NUMBER: 02-CC-20220504100555
FACILITY NAME:KID TIME, INC.FACILITY NUMBER:
073408918
ADMINISTRATOR:CASWELL, ANGELAFACILITY TYPE:
830
ADDRESS:2551 PLEASANT HILL ROADTELEPHONE:
(925) 930-6550
CITY:PLEASANT HILLSTATE: CAZIP CODE:
94523
CAPACITY:12CENSUS: 6DATE:
05/09/2022
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Angela CaswellTIME COMPLETED:
11:48 AM
ALLEGATION(S):
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Personal rights - Facility did not meet infant's dietary needs
INVESTIGATION FINDINGS:
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On 5/9/22 at 9:15 am Licensing Program Analysts (LPAs) Monica Mathur and Christina Watts conducted an unannounced Complaint Investigation at Kid Time, Inc - infant program. LPAs met with Director, Angela Caswell and explained purpose of investigation. During course of the investigation, LPAs inspected the facility, reviewed records and conducted interviews. It was determined that staff switched two infants milk bottles and an infant was fed another infant's milk bottle. This posed an immediate risk to health and safety of child/children in care. Facility failed to provide safe, healthful accomodations to children in care and is a violation of their personal rights,
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Based on the interviews and information obtained throughout the investigation, the preponderance of evidence standard has been met. Therefore, the allegation is SUBSTANTIATED. California Code of Regulations, Title 22, Division 12 is being cited on 9099-D page.

continued on 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 02-CC-20220504100555
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 073408918
VISIT DATE: 05/09/2022
NARRATIVE
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continued from 9099

LPA Monica Mathur informed Director Angela Caswell that this report dated 5/9/22 with 1 Type A citation which shall be posted for 30 consecutive days as there is immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Mathur informed the Director Angela Caswell to provide a copy of this licensing report dated 5/9/22 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

Exit interview conducted and report was reviewed with the Director Angela Caswell.
A NOTICE OF SITE VISIT WAS ISSUED AND MUST BE POSTED FOR 30 DAYS.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 02-CC-20220504100555
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 073408918
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/10/2022
Section Cited
CCR
101223(a)(2)
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101223 Personal Rights (a)The licensee shall ensure that each child is accorded the following personal rights (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement is not met as evidenced by:
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By POC Due Date 5/10/22 Director agreed to send a written report on what trainings and corrective procedures have been put into place since the incident so that it does not happen again; and their plan on how to bring facility back in compliance.
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Per LPA's investigation, staff switched two infants milk bottles and an infant was fed another infant's milk bottle. This is a violation of personal rights and posed an immediate risk to health and safety of child/children in care.
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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.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Monica Mathur
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3