<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376600729
Report Date: 09/17/2024
Date Signed: 09/17/2024 10:21:22 AM


Document Has Been Signed on 09/17/2024 10:21 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501



FACILITY NAME:CHILDTIME CHILDREN'S CENTER-INFANTFACILITY NUMBER:
376600729
ADMINISTRATOR:NIKOLE DUMASFACILITY TYPE:
830
ADDRESS:4280 VIA RANCHO ROADTELEPHONE:
(760) 967-5846
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY:24CENSUS: 17DATE:
09/17/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Nikole DumasTIME COMPLETED:
10:30 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
This is an amended report to a visit conducted on 05/21/2024.

On 09/17/2024, Licensing Program Analysts (LPAs) Sumayya Habeebulla and Kelly Gerth made an unannounced visit for a Case Management visit to deliver an amended report for an annual visit Case report conducted on 05/21/24.



LPAs met with Nikole Dumas to correct errors in the report pertaining to the deficiency/summary of the report.

Facility was toured and census was taken.

An exit interview was conducted, signatures were obtained for the amended page and a copy of this report was provided to facility director.

A notice of site visit was also provided, and facility representative Nikole Dumas was reminded the notice must be posted for 30 consecutive days.

SUPERVISOR'S NAME: Carlos MartinezTELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Sumayya HabeebullaTELEPHONE: 951-201-1991
LICENSING EVALUATOR SIGNATURE:
DATE: 09/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/16/2024
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 1