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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334808529
Report Date: 02/01/2023
Date Signed: 02/01/2023 03:08:36 PM

Document Has Been Signed on 02/01/2023 03:08 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, 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:
9516934843
CITY:TEMECULASTATE: CAZIP CODE:
92591
CAPACITY: 96TOTAL ENROLLED CHILDREN: 107CENSUS: 68DATE:
02/01/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Abbey LewisTIME COMPLETED:
03:25 PM
NARRATIVE
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Licensing Program Analyst (LPA) Sumayya Habeebulla made an unannounced visit to the facility for another purpose.

During the tour of the facility it was observed two staff who were present at the facility were not reflecting as finger print cleared and associated to the facility. LPA requested the files of both the staff and many required Licensing documents along with clearance documentation were missing in the staff files. LPA contacted the department to verify the clearance and association of the 2 staff and it was noted that Staff 1 has active clearance but is not associated to any facilities on Guardian. Whereas staff 2 is not present on Guardian.

See LIC 809D for cited deficiencies.

An Exit Interview was conducted, A Notice of Site visit was given, and the Facility Representative understands that it must remain posted for 30 days

SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE: DATE: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/01/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
Document Has Been Signed on 02/01/2023 03:08 PM - It Cannot Be Edited


Created By: Sumayya Habeebulla On 02/01/2023 at 02:00 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
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/02/2023
Section Cited
CCR
101170(e)(1)

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(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:
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>>>Based on record review, licensee did not comply with the section cited above as S2 did not have a fingerprint/criminal record clearance which poses an immediate health, safety or personal rights risk to persons in care.
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(1) Obtain a California clearance or a criminal record exemption as required by the Department ...

This requirement is not met as evidenced by: >>>
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Director agrees to not allow S2 at the facility until the facility provides proof of completed background/fingerprint clearance and association to the Department by the POC due date. S2 left facility while LPA still present.

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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:Carlos Martinez
LICENSING EVALUATOR NAME:Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2023


LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 02/01/2023 03:08 PM - It Cannot Be Edited


Created By: Sumayya Habeebulla On 02/01/2023 at 02:10 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
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/03/2023
Section Cited
CCR
101170(e)(1)

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(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1596.871 shall prior to working, residing or volunteering in a licensed facility:
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>>>Based on record review, licensee did not comply with the section cited above as S1 has an active clearance but is not associated to the facility which poses a potential health, safety or personal rights risk to persons in care.
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(1) Obtain a California clearance or a criminal record exemption as required by the Department ...

This requirement is not met as evidenced by: >>>
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Director agrees to not allow S1 at the facility until associated to the facility and submits proof to the Department by the POC due date. S1 left the facility during LPAs visit

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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:Carlos Martinez
LICENSING EVALUATOR NAME:Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2023


LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 02/01/2023 03:08 PM - It Cannot Be Edited


Created By: Sumayya Habeebulla On 02/01/2023 at 02:13 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
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/06/2023
Section Cited
HSC
1596.7995(a)(1)

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(a) (1) Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles.
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>>>on file which poses a potential health, safety or personal rights risk to persons in care. Director of the facility agrees to obtain the proof of immunization and submit it to the department by the POC due date.
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This requirement is not met as evidenced by:
Based on record review, licensee did not comply with the section cited above as S2 did not have proof of immunization >>>
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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:Carlos Martinez
LICENSING EVALUATOR NAME:Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2023


LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 02/01/2023 03:08 PM - It Cannot Be Edited


Created By: Sumayya Habeebulla On 02/01/2023 at 02:28 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
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/06/2023
Section Cited
CCR
101217

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(a) (b) (c) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information....
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>>> Licensing forms present in their files for the Department to review which poses a potential health, safety or personal rights risk to persons in care >>>
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This requirement is not met as evidenced by:
Based on record review, licensee did not comply with the section cited above as S1 and S2 did not have the required >>>
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>>> Director of the facility agrees to submit all required Licensing documents to the department by the POC due date. LPA provided a list of required Personnel Record documents that need to be submitted.

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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:Carlos Martinez
LICENSING EVALUATOR NAME:Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2023


LIC809 (FAS) - (06/04)
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