041370378-4-21-2023-13-CC-JSNW-CR2U4F-20230419151505

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 041370378
Report Date: 04/19/2023
Date Signed: 04/21/2023 04:12:10 PM

Document Has Been Signed on 04/21/2023 04:12 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
CHICO-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME:	HELEN WILCOX PRESCHOOL		FACILITY NUMBER:	041370378
ADMINISTRATOR:	BUTCHER, KIMBERLY		FACILITY TYPE:	850
ADDRESS:	5727 AUTREY LANE		TELEPHONE:	(530) 533-4842
CITY:	OROVILLE	STATE: CA	ZIP CODE:	95966
CAPACITY:	60	CENSUS: 29	DATE:	04/19/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:28 PM
MET WITH:	Jodie Duggins		TIME COMPLETED:	03:45 PM

NARRATIVE

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On April 19, 2023 at 1:30pm an annual inspection was made to the facility by Licensing Program Analyst (LPA), J Snow who met with Jodie Duggins . 3 staff were caring for 18 children in one room; 3 staff were caring for another 11 children. This program is operated by public agency) and a Title 5 funded program. Hours of operation are from 7:30-5:30pm Monday–Friday. The facility was toured at 2pm inside and outside and the floor and yard plan submitted by the licensee were verified. Facility operates in Rooms 22A (two half day programs & 22B (full day program).

The site supervisor Jodie Duggins was supervising 19 children and operating within the licensed capacity and ratio requirements. There are no pools or bodies of water on the premises.

5 children's records were reviewed and 3 staff records at 215 pm. Jodie Duggins said she did not have access to the staff files as they are kept off premises.

Jodie Duggins was reminded that all adults 18 and over, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a Child Care Center. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

This facility provides Incidental Medical Services – IMS. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records.

SUPERVISOR'S NAME: Erin Virrueta	TELEPHONE: (530) 966-0216
LICENSING EVALUATOR NAME: Jaime Snow	TELEPHONE: (530)215-6132
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: HELEN WILCOX PRESCHOOL	FACILITY NUMBER: 041370378
	VISIT DATE: 04/19/2023

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For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Jodie Duggins

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

The following deficiencies were cited for an expired medication for Child (C1) see LIC 809D:

SUPERVISOR'S NAME: Erin Virrueta	TELEPHONE: (530) 966-0216
LICENSING EVALUATOR NAME: Jaime Snow	TELEPHONE: (530)215-6132
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/21/2023 04:12 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: HELEN WILCOX PRESCHOOL	FACILITY NUMBER: 041370378
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/19/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

101226(e)(4)(B)

Health-Related Services

(4) Nonprescription medications may be administered without approval or instructions from the child's physician if all of the following conditions are met: (B) For each nonprescription medication, the licensee shall obtain, in writing, approval and instructions from the child's authorized representative for the administration of the medication to the child. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, record reviews and statements from the site supervisor; the licensee did not comply with the section cited above in one out of one medications observed for C1 which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/28/2023
	Plan of Correction
1 2 3 4	Replace expired medication, maintain required documents (training &documents listed in the Incidental medical services plan submitted to the department) and provide a staff training on the incidental medication plan that was submitted to the CCL department.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Erin Virrueta	TELEPHONE: (530) 966-0216
LICENSING EVALUATOR NAME: Jaime Snow	TELEPHONE: (530)215-6132
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2023

LIC809 (FAS) - (06/04)

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