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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 03:54:15 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
09/22/2021 and conducted by Evaluator Jeovanna Yanez
PUBLIC
COMPLAINT CONTROL NUMBER: 04-CC-20210922102931
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:
02:00 PM
MET WITH:Karen KiserTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Facility closet is in disrepair.
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.

Upon entry into the facility, LPAs observed a closet/cabinet in the "nap room" that to be in disrepair having a broken hinge on the top left side and appearing to look open while closed. The closet is located on the left side corner of the nap room and is large in size. Director indiciated due to the closet being broken, staff move children out of this room to remove the cots from this closet and store them away after nap time.

Based upon LPAs observations and interviews with staff, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 12, Chapter 1, the following deficiency is being cited (see 9099-D). Continued on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Diana deLeon
LICENSING EVALUATOR NAME: Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021
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
Control Number 04-CC-20210922102931
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
09/29/2021
Section Cited
CCR
101239(n)
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Fixtures, Furniture, Equipment and Supplies (n) Furniture and equipment shall be maintained in good condition, free of sharp, loose or pointed parts. This requirement was not met as evidenced by LPAs observation and interviews with staff. Director confirmed a closet in the "nap room" was in disrepair and
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Director stated she will have the closet in the "nap room" replaced with a brand new closet and will submit pictures of new closet to CCL by POC due date.
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is still in use for storage. 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: 09/22/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 04-CC-20210922102931
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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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: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 4