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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623499
Report Date: 05/21/2024
Date Signed: 05/21/2024 01:53:46 PM

Document Has Been Signed on 05/21/2024 01:53 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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:HAPPY TIME PRESCHOOLFACILITY NUMBER:
343623499
ADMINISTRATOR/
DIRECTOR:		PATEL, MAYAFACILITY TYPE:
850
ADDRESS:7610 ELSIE AVENUETELEPHONE:
(916) 698-0685
CITY:SACRAMENTOSTATE: CAZIP CODE:
95828
CAPACITY: 75TOTAL ENROLLED CHILDREN: 75CENSUS: 35DATE:
05/21/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Maya PatelTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
NARRATIVE
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On May 21, 2024 Licensing Program Analysts (LPAs) Mandie Goodwin and Gagandeep Singh were conducting a facility visit when it was learned that a child was injured and was taken to the emergency room by parent. Based on record review and interview this injury was not reported as required to department. Director stated that she did not report the injury to the department even though she was aware of the medical visit because she did not receive an official doctor's note and was not aware that it still had to be reported.

A type B deficiency is listed on 809-D. This is a repeat violation and a civil penalty of $250 was assessed. Exit interview with Director Maya Patel was conducted and appeal rights were provided.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Mandie Goodwin
LICENSING EVALUATOR SIGNATURE: DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/21/2024
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 05/21/2024 01:53 PM - It Cannot Be Edited


Created By: Mandie Goodwin On 05/21/2024 at 01:06 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: HAPPY TIME PRESCHOOL
FACILITY NUMBER: 343623499

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/21/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/04/2024
Section Cited
CCR
101212(d)

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Reporting Requirements: ...any of the events specified in (d)(1) below, a report shall be made to the Department...
(1) Events reported shall include the following:
....
(B) Any injury to any child that requires medical treatment.
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Director will review the reporting requirements and submit written understanding of the requirements.

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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:Seychelle De Luca
LICENSING EVALUATOR NAME:Mandie Goodwin
LICENSING EVALUATOR SIGNATURE:
DATE: 05/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/21/2024


LIC809 (FAS) - (06/04)
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