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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343604946
Report Date: 11/21/2023
Date Signed: 11/21/2023 01:48:43 PM


Document Has Been Signed on 11/21/2023 01:48 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:CHILDTIME CHILDREN'S CENTERFACILITY NUMBER:
343604946
ADMINISTRATOR:ROBERTS, DONYALEFACILITY TYPE:
830
ADDRESS:7901 LAGUNA BOULEVARDTELEPHONE:
(916) 691-3800
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY:25CENSUS: 9DATE:
11/21/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Donyale RobertsTIME COMPLETED:
03:30 PM
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On 11/21/2023, Licensing Program Analyst Katy Velazquez (LPA) conducted a field visit to the facility for the purpose of a Plan of Correction inspection. LPA arrived at the Center and was met by Director Donyale Roberts (D1). LPA disclosed the purpose of the inspection and was granted entrance into the facility.

During an Annual Random Inspection conducted on 10/19/2023, a deficiency was cited which related to the surface of the playground.The plan of correction due date was agreed upon for 12/01/2023; however, the repairs were concluded early. During today's inspection on 11/21/2023, LPA observed the repairs on the playground. LPA cleared the deficiency from 10/20/2023 and provided D1 with a letter of clearance.

An exit interview was conducted, and the report was reviewed with D1. LPA provided D1 with Licensee Appeal Rights. A Notice of Site visit was posted by LPA and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR NAME: Katy VelazquezTELEPHONE: 916-926-9100
LICENSING EVALUATOR SIGNATURE:
DATE: 11/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/21/2023
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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