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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 153808307
Report Date: 09/22/2021
Date Signed: 09/22/2021 03:46:16 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, 1310 E. SHAW AVE,
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/15/2021 and conducted by Evaluator Jeovanna Yanez
PUBLIC
COMPLAINT CONTROL NUMBER: 04-CC-20210715085732
FACILITY NAME:A GOOD TIME OUTFACILITY NUMBER:
153808307
ADMINISTRATOR:SHERMAN, MELANIE/KARENFACILITY TYPE:
850
ADDRESS:3400 CALLOWAY DRIVE, SUITE 501TELEPHONE:
(661) 410-8463
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY:31CENSUS: 33DATE:
09/22/2021
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Karen KiserTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Facility staff did not ensure that children's immunization records are up to date.
Facility staff did not notice a change in the child's condition.
INVESTIGATION FINDINGS:
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On 09/22/2021, Licensing Program Analysts (LPAs) Jeovanna Yanez and Jessika Thompson arrived at the facility to conduct an unannounced complaint inspection. The purpose of the inspection was to gather information regarding the above listed complaint allegations and deliver investigation findings. LPAs met with Director, Karen Kiser, and a census was taken. During the course of this investigation, LPAs reviewed records and interviewed staff, parents, and children.

Regarding staff not ensuring that children's immunization records are up to date, record review indicated that some children's files were not up to date with current immunizations. Additionally, during an interview, Staff #1 indicated they try to work with parents to obtain updates immunization records for children at the facility; however, there are instances when parent's fail to provide those records. (Continued on LIC9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Diana deLeon
LICENSING EVALUATOR NAME: Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2021
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/15/2021 and conducted by Evaluator Jeovanna Yanez
PUBLIC
COMPLAINT CONTROL NUMBER: 04-CC-20210715085732

FACILITY NAME:A GOOD TIME OUTFACILITY NUMBER:
153808307
ADMINISTRATOR:SHERMAN, MELANIE/KARENFACILITY TYPE:
850
ADDRESS:3400 CALLOWAY DRIVE, SUITE 501TELEPHONE:
(661) 410-8463
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY:31CENSUS: 33DATE:
09/22/2021
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Karen KiserTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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9
Facility staff left child in soiled clothing for an extended period of time.
INVESTIGATION FINDINGS:
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On 09/22/2021, Licensing Program Analysts (LPAs) Jeovanna Yanez and Jessika Thompson arrived at the facility to conduct an unannounced complaint inspection. The purpose of the inspection was to gather information regarding the above listed complaint allegation and deliver investigation findings. LPAs met with Director, Karen Kiser and a census was taken. During the course of this investigation, LPAs reviewed records and interviewed staff, parents, and children.

Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is UNSUBSTANTIATED. Per California Code of Regulations, Title 22, Division 12, Chapter 1, no deficiency was cited during today's inspection.

An exit interview was conducted with Karen Kiser. A copy of this report and Appeal Rights were provided and discussed. A Notice of Site Visit (LIC 9213) form will be posted on the facility's parent's board and must remain posted for 30 days.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Diana deLeon
LICENSING EVALUATOR NAME: Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 04-CC-20210715085732
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: A GOOD TIME OUT
FACILITY NUMBER: 153808307
VISIT DATE: 09/22/2021
NARRATIVE
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Regarding staff not noticing a change in a child's condition, staff interviewed stated they are observant of children in care and will contact parents if a child is sick; however, during a parent interview conducted, it was indicated that on one occasion a child was picked up from care and looked sick. Additionally, LPA received documentation from a parent that indicates the child was taken to an Urgent Care clinic and received a medical diagnosis after being in care at the facility.

Based upon records review and information gathered through interviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 12, Chapter 1, the following deficiencies are being cited (see 9099-D).

An exit interview was conducted with Karen Kiser. A copy of this report and Appeal Rights were provided and discussed. A Notice of Site Visit (LIC 9213) form will be posted on the facility's parent's board and must remain posted for 30 days.

SUPERVISORS NAME: Diana deLeon
LICENSING EVALUATOR NAME: Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 04-CC-20210715085732
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: A GOOD TIME OUT
FACILITY NUMBER: 153808307
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/22/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/05/2021
Section Cited
CCR
101221(f)
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Child's Records (f) The information specified in (b)(1) through (b)(12) above shall be updated as necessary to ensure the accuracy of the child's record. This requirement was not met as evidenced by record review. Multiple children's files did not have updated immunization records for children who attend
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Director stated she will submit a written statement detailing methods that will be used to ensure that immunization records will be updated for children on a contract to CCL by POC due date.
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the facility on a regular basis and are on a contract. This poses a potential risk to the health, safety and personal rights of children in care.
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Type B
10/05/2021
Section Cited
CCR
101226.3
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Observation of the Child (a) The behavior and health of the children shall be continually observed throughout ... attendance. (b) Any unusual behavior ... or signs of illness requiring assessment ... shall be reported to the child's authorized representative and recorded in the child's record.
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Director stated she will have a meeting with staff in small groups to discuss this topic and submit documentation of meetings occuring to CCL by POC due date.
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This requirement was not met as evidenced by information gathered from interview with parent and documentation received. This poses a potential risk to the health, safety, and personal rights of 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: Diana deLeon
LICENSING EVALUATOR NAME: Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 4