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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600638
Report Date: 12/07/2022
Date Signed: 12/08/2022 10:56:06 AM

Document Has Been Signed on 12/08/2022 10:56 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, 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:
12/07/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Jessica DornTIME COMPLETED:
02:30 PM
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On 12/07/22 at 1:45pm Licensing Program Analyst (LPA) Adrian Castellon conducted an unannounced inspection to follow up on a self reported incident that occurred on 10/19/2020. Child in care received a small cut inside of his mouth while in the infant classroom, LPA Castellon met with Director Jessica Dorn and discussed the purpose of the inspection.

LPA examined the area and piece of furniture that child hit his mouth on. The piece of furniture is in good condition and free of sharp edges or points. On day of incident there were six (6) children in care and two (2) staff members in the classroom. LPA Castellon interviewed one staff member who was present and parent of child involved in the incident. Staff placed child on ground and child was standing. Staff observed chid lose balance and bend over and hit his mouth on the wooden piece of furniture. LPA Castellon took a picture of the furniture. Staff applied first aid. Cut was cleaned , pressure was applied and ice was applied. Parent was advised immediately at the time the incident as parent is employed at the facility. Parent took child to see seek professional medical assistance. Child did not receive stitches.

Supervision was in place, ratios were met and staff responded appropriately. The facility met reporting requirements with licensing office and parent.

No deficiencies are cited. Provided Notice of Site Visit (LIC 9213). Exit interview conducted.
SUPERVISORS NAME: Cynthia Gray
LICENSING EVALUATOR NAME: Adrian Castellon
LICENSING EVALUATOR SIGNATURE: DATE: 12/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/07/2022
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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