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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153808447
Report Date: 07/21/2021
Date Signed: 07/21/2021 01:45:20 PM

Document Has Been Signed on 07/21/2021 01:45 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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:A GOOD TIME OUTFACILITY NUMBER:
153808447
ADMINISTRATOR:MELANIE SHERMANFACILITY TYPE:
830
ADDRESS:3400 CALLOWAY DRIVE, SUITE 502TELEPHONE:
(661) 410-8463
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY: 17TOTAL ENROLLED CHILDREN: 0CENSUS: 10DATE:
07/21/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Melanie Sherman - Director TIME COMPLETED:
10:40 AM
NARRATIVE
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On 7/21/21, Licensing Program Analysts (LPAs) Jessika Thompson and Jeovanna Yanez conducted a Case Management Inspection. LPAs met with Director Melanie Sherman. The purpose of this inspection was to discuss a deficiency observed at the facility. Today, upon arrival, LPAs witnessed two staff members providing direct care and supervision to ten infants. Additional staff were observed to be in place in other areas of the facility; however, they were not aiding in providing visual observation of the aforementioned infants at the time of this occurrence.

Per Title 22, Division 12, Chapter 1, of the California Code of Regulations, the following deficiency is being cited: (see next page, LIC809-D). Licensee was provided a copy of their appeal rights.

This report shall be made available to the public upon request. LIC 9213 Notice of Site Visit is provided and required to be posted for 30 days.

SUPERVISORS NAME: Diana deLeon
LICENSING EVALUATOR NAME: Jessika Thompson
LICENSING EVALUATOR SIGNATURE: DATE: 07/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/21/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/21/2021 01:45 PM - It Cannot Be Edited


Created By: Jessika Thompson On 07/21/2021 at 11:36 AM
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
, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: A GOOD TIME OUT
FACILITY NUMBER: 153808447

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/21/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/20/2021
Section Cited
CCR
101216.5(b)

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There shall be a ratio of one teacher for every four infants in attendance. This requirement was not met as evidenced by LPAs observations. Today, LPAs observed two staff members providing direct care and supervision to ten infants.
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Licensee indicated she will provide staff with training regarding Title 22 Regulation 101216.5(b). This training to include the viewing of Community Care Licensing (CCL) video titled "Teacher to Child Ratios in Child Care Centers".
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This poses a potential risk to the health, safety, or personal rights of children in care.
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This video can be viewed by accessing the Department's website: childcarevideos.org.
Licensee to submit a copy of training outline, and list of attendees to the Fresno CCL office by 8/20/21.

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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:Diana deLeon
LICENSING EVALUATOR NAME:Jessika Thompson
LICENSING EVALUATOR SIGNATURE:
DATE: 07/21/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/21/2021


LIC809 (FAS) - (06/04)
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