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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 045403573
Report Date: 11/04/2021
Date Signed: 11/09/2021 09:40:10 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/13/2021 and conducted by Evaluator Bianca Mendez
COMPLAINT CONTROL NUMBER: 13-CC-20211013083316
FACILITY NAME:ASSOCIATED STUDENTS CHILDREN'S CENTERFACILITY NUMBER:
045403573
ADMINISTRATOR:HANSEN, JACKIEFACILITY TYPE:
830
ADDRESS:CSU CHICOTELEPHONE:
(530) 898-5865
CITY:CHICOSTATE: CAZIP CODE:
95929
CAPACITY:16CENSUS: 5DATE:
11/04/2021
UNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Jackie HansenTIME COMPLETED:
11:05 AM
ALLEGATION(S):
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Staff did not follow infant feeding plans
INVESTIGATION FINDINGS:
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On 11/4/21 at 10:50am , Licensing Program Analyst (LPA) Mendez conducted an unannounced complaint inspection, and met with director Jackie Hansen. It was alleged that staff did not follow infants feeding plan.
The director was interviewed on 10/18/21 at 10:10am and stated that there was a mix up in the formula and provided the documentation that confirmed that child (C1)’s formula had been corrected with parent (P1). Director stated that they take responsibility for the mistake in giving child the wrong formula. LPA Mendez asked director if (C1) had an allergic reaction when (C1) was given the wrong formula and stated no, (C1) drank formula very minimal while in care.
LPA Mendez interviewed parent (P1) on 10/15/21, LPA Mendez asked P1 if formula had been corrected, P1 stated that it had been corrected and confirmed correction with director and staff.
Based on the evidence obtained, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, (Title 22), is being cited on the attached LIC 9099D. Appeal rights were provided and exit interview conducted. The Notice of Site Visit must be posted for 30 days.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Bianca Mendez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 13-CC-20211013083316
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: ASSOCIATED STUDENTS CHILDREN'S CENTER
FACILITY NUMBER: 045403573
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/04/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/04/2021
Section Cited
CCR
101427(b)(1)(2)
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101427(b)(1)(2) There shall be an individual feeding plan for each infant. The plan shall be completed and available for the use prior to the infant’s first day at the center. The director or the assistant director, and the infant’s authorized representee and/or physician, shall develop the plan.
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Director will have parent complete a new updated form regarding the corrected formula for child.Plan of correction is to be submitted by 11/8/21 to LPA Mendez.
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This requirement was not met as evidence, director admitted their was mix up in child's formula and child was given the wrong formula
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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.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Bianca Mendez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/13/2021 and conducted by Evaluator Bianca Mendez
COMPLAINT CONTROL NUMBER: 13-CC-20211013083316

FACILITY NAME:ASSOCIATED STUDENTS CHILDREN'S CENTERFACILITY NUMBER:
045403573
ADMINISTRATOR:HANSEN, JACKIEFACILITY TYPE:
830
ADDRESS:CSU CHICOTELEPHONE:
(530) 898-5865
CITY:CHICOSTATE: CAZIP CODE:
95929
CAPACITY:16CENSUS: DATE:
11/04/2021
UNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Jackie HansenTIME COMPLETED:
11:05 AM
ALLEGATION(S):
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Staff are not properly santizing the facility
INVESTIGATION FINDINGS:
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On 11/3/21 at 10:54am, Licensing Program Analyst (LPA) Mendez conducted an unannounced complaint inspection, and met with director Jackie Hansen. It was alleged that staff are not properly sanitizing the facility
The director was interviewed on 10/18/21 at 10:10am and denied the allegations that staff are not properly sanitizing the facility. Director Jackie Hansen stated that all staff sanitize daily and follow through with cleaning and disinfecting guidelines.
LPA Mendez interviewed three staff on 10/18/21, LPA Mendez asked staff how often they sanitize children’s toys, play space and surface, three out of three staff stated that they sanitize daily using a bleach to water ratio for sanitizing surfaces. Staff (S1-S3) stated that children’s toys go in a bin and are washed with soap and water throughout the day. LPA Mendez asked staff if there has been multiple children sick around the same time staff (S1-S3) stated that children have had a cough and runny nose. Staff (S1-S3) stated that staff communicate with parents when children are not feeling well.
LPA Mendez interviewed ten parents on 10/15/21, 10/20/21, 10/21/21 and 11/3/21.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Bianca Mendez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 13-CC-20211013083316
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: ASSOCIATED STUDENTS CHILDREN'S CENTER
FACILITY NUMBER: 045403573
VISIT DATE: 11/04/2021
NARRATIVE
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LPA Mendez asked parents (P1-P10) if they had any concerns regarding the cleanliness of the facility, P1 stated that that staff are not sanitizing toys or sanitizing the facility. Parents (P2-P10) had no concerns regarding the cleanliness of the facility, they stated that staff clean and sanitize the surfaces and clean children’s toys. Parents (P1-P10) stated they had received an email from Chico State Associated Students, that they would be implementing covid guidelines, parents drop off and pick up at the door and are not allowed inside classroom.

LPA Mendez asked ten parents if they have witnessed staff cleaning the facility, 2 out of 10 parents stated that they have not witnessed staff cleaning. P1 stated that they have not seen staff sanitizing surfaces. P9 stated that they have not seen staff sanitizing surfaces because parents are not allowed in the classroom and does drop off and pick up at the door.


Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred, and the findings are unsubstantiated. An exit interview was conducted. The Notice of Site Visit must be posted for 30 days.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Bianca Mendez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 4