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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600638
Report Date: 01/10/2024
Date Signed: 01/10/2024 03:48:29 PM

Document Has Been Signed on 01/10/2024 03:48 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
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:CHILDTIME CHILDREN'S CENTER - CHULA VISTA INFANTFACILITY NUMBER:
376600638
ADMINISTRATOR:JESSICA DORNFACILITY TYPE:
830
ADDRESS:770 RANCHO DEL REY PARKWAYTELEPHONE:
(619) 397-0165
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: DATE:
01/10/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Jessica DornTIME COMPLETED:
03:50 PM
NARRATIVE
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On January 10, 2024 at 1:00 PM Licensing Program Analyst (LPAs), Adrian Castellon conducted an unannounced Case Management Inspection. LPA met with Director Jessica Dorn and discussed the purpose of the inspection. LPA arrived to investigate a self reported incident. On 1/3/2024, the facility self reported the incident to the SDCCRO via the Duty Line. The facility reports that on 1/3/2024 at approximately 1:20 PM, a five month old child C1 was fed a bottle (breast milk) belonging to an eight month old child C2. C1 was given the bottle for approximately 30 seconds before the error was noticed. C2 was then given the remainder of the bottle after nipple was washed. Parents of C1 and C2 were advised of incident.

On today's date, LPAs conducted interviews with two staff members present in the class at the time of the incident. LPA Castellon interviewed parent of C1 on this date. Two type B deficiencies cited on today's date. Please see LIC809D.

Report was reviewed with director. Appeal rights were discussed and given to director. Notice of Site Visit must be posted for 30 days.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Adrian Castellon
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2024
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 2
Document Has Been Signed on 01/10/2024 03:48 PM - It Cannot Be Edited


Created By: Adrian Castellon On 01/10/2024 at 02:44 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
, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108

FACILITY NAME: CHILDTIME CHILDREN'S CENTER - CHULA VISTA INFANT
FACILITY NUMBER: 376600638

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/10/2024
Section Cited
CCR
101223(a)(2)

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101223 Personal Rights (a) The licensee shall ensure that each child is accorded the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement is not met as evidenced by:
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Director has agreed to conduct a training with staff regarding personal rights and feeding procedures in the infant classrooms. Director will provide a summary of the training and a copy of the staff sign in sheet to LPA, no later than 1/20/2023. Staff members in classrooms are instructed to verify that bottle
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Based on interviews conducted and self reported incident, infant was fed wrong bottle of breast milk and then another infant was fed the remainder of that bottle, which poses a potential health, safety or personal rights risk to persons in care.
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is being fed to correct child everytime a bottle will be used. Both staff members must agree that correct bottle is being fed to correct child.

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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:Cynthia Gray
LICENSING EVALUATOR NAME:Adrian Castellon
LICENSING EVALUATOR SIGNATURE:
DATE: 01/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/10/2024


LIC809 (FAS) - (06/04)
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