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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334808529
Report Date: 09/29/2021
Date Signed: 04/08/2022 09:49:34 AM

Document Has Been Signed on 04/08/2022 09:49 AM - 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:CHILDTIME CHILDREN'S CENTERFACILITY NUMBER:
334808529
ADMINISTRATOR:ABBY LEWISFACILITY TYPE:
850
ADDRESS:27321 NICHOLAS ROADTELEPHONE:
(951) 693-4843
CITY:TEMECULASTATE: CAZIP CODE:
92591
CAPACITY: 96TOTAL ENROLLED CHILDREN: 96CENSUS: 44DATE:
09/29/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:47 PM
MET WITH:Abby LewisTIME COMPLETED:
02:35 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Ana Noble and Sumayya Habeebulla arrived at the facility on a case management inspection to follow-up on an Unusual Incident Report (UIR) which occurred on February, 11, 2020. At the time of visit, LPAs toured the facility, took census, interviewed and met with Site Supervisor - Abbey Lewis to discuss the purpose of the visit.

The reported incident took place on February 11, 2020. as reported by the facility, while the class was lining up for Playground time, Child #1 was having difficulty following directions and separated from the group. When the group arrived at the playground, Staff #1 realized Child #1 was missing from the group. Staff #2 had found the child still in the classroom, Child #1 was then led by Staff #2 to the playground.

After review of facility documentation and interviews conducted with Abby Lewis, Director as well as the center's report of the incident as indicated above there is a violation of Title 22 Regulations pertaining to this reported incident. See LIC809D for cited deficiencies

An exit interview was conducted with the Director Abbey Lewis, Director-appeal rights discussed and a copy of this report was provided.
SUPERVISORS NAME: Stephanie Hudak
LICENSING EVALUATOR NAME: Ana Noble
LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2021
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 04/08/2022 09:50 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 04/05/2022 09:21 AM


Created By: Ana Noble On 09/29/2021 at 01:25 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
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: CHILDTIME CHILDREN'S CENTER
FACILITY NUMBER: 334808529

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/29/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
09/30/2021
Section Cited
CCR
101229(a)(1)

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Responsibility for Providing Care and Supervision. No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation. This requirement was not met by evidence of: On 2/11/2020,
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The Center Director agrees to conduct training with all staff regarding this regulation and the importance of ensuring all children are account for during transitioning periods. Submit a copy of the agenda reviewed with staff and signatures of acknowledgement with all staff signatures to the Department by 9/30/2021.
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as reported by the facility, Child #1 was left behind in the classroom while, all children and staff transitions from indoor activities to outdoor playtime. Child was found alone in the classroom by another staff. This is an potential health and safety risk to children if not corrected.
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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:Stephanie Hudak
LICENSING EVALUATOR NAME:Ana Noble
LICENSING EVALUATOR SIGNATURE:
DATE: 09/29/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/29/2021


LIC809 (FAS) - (06/04)
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