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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045404933
Report Date: 05/25/2023
Date Signed: 05/25/2023 03:40:57 PM


Document Has Been Signed on 05/25/2023 03:40 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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926



FACILITY NAME:E CENTER HS PGMS - FAIRVIEW CENTERFACILITY NUMBER:
045404933
ADMINISTRATOR:HIGGS, CAROLFACILITY TYPE:
830
ADDRESS:290 EAST AVE.TELEPHONE:
(530) 891-3092
CITY:CHICOSTATE: CAZIP CODE:
95973
CAPACITY:20CENSUS: 0DATE:
05/25/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:22 PM
MET WITH:Teresa BordersTIME COMPLETED:
03:50 PM
NARRATIVE
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On 5/25/23 at 3:22 pm a case management visit was conducted by Licensing Program Analyst (LPA) B. Mendez, in response to an unusual incident that was self reported in a timely manner by Noheli Santillan, Area Manager. The incident occurred on 5/10/23 at approximately 11:00am. Community Care Licensing Division (CCLD) was notified within 24 hours and unusual incident report was sent in writing within the 7 days as required. It was reported that Staff (S1) had left a child, a 15 month old infant (C1) outside on the playground when children were transitioning from outside to inside.

LPA interviewed a total of 6 staff (S1-S6). Staff (S1) stated that they were transitioning from outside to inside the classroom and went outside to take children into the classroom and S2 was present with the children. S1 stated as they transitioning to the classroom, they took two children inside the classroom and began setting up for lunch. S1 stated that they had looked up and realized that C1 was not there and asked S3 if they were changing C1’s diaper, this is when S1 realized that C1 was still outside. S1 stated that C1 was left outside for 2 minutes. S2 stated that before the incident they were outside with 3 children and S1 came to give them a lunch break, S2 stated that they informed S1 that there were 7 children in the classroom. LPA asked S2 if they informed S1 about how many children were outside in which S2 stated they did not remember. LPA interviewed S3 and asked where were they during the incident and they stated that they were changing diapers during the incident. LPA asked how long the child was left outside for and S3 stated about 2 minutes. LPA interviewed S4 and asked S4 where were they when the incident occurred, S4 stated that they were in the classroom and LPA asked how long was C1 left outside in which S4 stated about 3 minutes. LPA interviewed S5 and S6 who were not present during the incident but were aware of the incident and reported it to licensing.

SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Bianca MendezTELEPHONE: (530) 895-4357
LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2023
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
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: E CENTER HS PGMS - FAIRVIEW CENTER
FACILITY NUMBER: 045404933
VISIT DATE: 05/25/2023
NARRATIVE
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LPA Mendez interviewed parent (P1) on 5/23/23 and asked if they were aware of the incident and P1 stated that they were not notified until days after the incident occurred.

It has been determined through interviews that a child was left on the playground outside, with no supervision for approximately 2-3 minutes. This presents an immediate risk to the health and safety of children in care. The following violation of the California Code of Regulations, Tittle 22: Division 12 was observed: see LIC 809D. Reports citing Type A violations are to be provided to parents/guardians of children currently in enrolled should sign LIC 9224 form and to parents/guardians of children newly enrolled at the facility during the next 12 months.

Notice of Site Visit shall be posted for 30 days from today’s visit.

SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Bianca MendezTELEPHONE: (530) 895-4357
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3
Document Has Been Signed on 05/25/2023 03:40 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
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926


FACILITY NAME: E CENTER HS PGMS - FAIRVIEW CENTER
FACILITY NUMBER: 045404933

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/25/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/25/2023
Section Cited
CCR
101229(a)(1)

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(a)The licensee shall provide care and supervision as necessary to meet the children's needs.(1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
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All employess are required to do their counts outloud and communicate numbers at all time. Staff have gone through safety and supervision training. Also using count board.
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This was not met as evidence by: based on interviews and record review, C1 was unsupervised for 2-3 minutes on the playground while class was transitioning from outside. This poses an immediate health, safety, or personal rights risk to persons in care.
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All parents should have a signed LIC 9224 in children's file for new and currently enrolled children.
Plan of action to be submitted to CCL by 5/26/23

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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: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Bianca MendezTELEPHONE: (530) 895-4357
LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2023
LIC809 (FAS) - (06/04)
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