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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 065406934
Report Date: 07/24/2019
Date Signed: 08/02/2019 04:33:47 PM

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:COLUSA PRESCHOOL LEARNING CENTER A & BFACILITY NUMBER:
065406934
ADMINISTRATOR:MARKSS, VICKIFACILITY TYPE:
850
ADDRESS:723 6TH STREETTELEPHONE:
(530) 458-4458
CITY:COLUSASTATE: CAZIP CODE:
95932
CAPACITY:48CENSUS: 18DATE:
07/24/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Angela PadillaTIME COMPLETED:
11:55 AM
NARRATIVE
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A Case Management inspection was made to the facility by Licensing Program Analyst (LPA) Laura Chavez in response to an unusual incident report received involving a child falling from a play structure located at a local park. On 7/10/2019 at approximately 10:45am, Child #1 jumped from the platform of a climbing play structure to a fireman sliding pole and fell over 5 1/2' to the ground. Child #1 was interviewed at 9:50am and stated she missed the pole when attempting to get off the play structure. LPA toured the local park prior to the facility inspection. Staff 1 - 4 were interviewed and stated no one saw how Child #1 fell. Staff #1 stated she was assisting children in tying their shoes as they lined up to prepare to walk back to the facility. S#2 stated she and other staff were asking children to get off the play structure and line up to return to the facility. S#3 stated she was assisting children in lining up on the opposite side of the large slide which blocked visual of where Child #1 fell. S#4 stated she was assisting a child who asked for help on getting off the rock climbing wall when Child #1 fell. Parent of Child #1 was notified. The incident was reported to Community Care Licensing within the required time frame. This incident constitutes a lack of supervision. All licensing reports are public information and must be made available upon request for at least three years.
Notice of Site Visit shall be posted for 30 days from today's visit.

The following Type A violation of the California Code of Regulations, Title 22 was cited: see LIC 809D.

Reports citing Type A violations are to be provided to parents/guardians of children currently in care of the facility and to parents/guardians of children newly enrolled at the facility during the next 12 months. During today's visit a copy of the licensee's appeal rights and Form LIC9224, Acknowledgement of Receipt of Licensing Reports were provided to the licensee.
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura ChavezTELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2019
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: COLUSA PRESCHOOL LEARNING CENTER A & B
FACILITY NUMBER: 065406934
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/24/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/25/2019
Section Cited
CCR
101229(a)(1)
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Responsibility for Providing Care and Supervision. The licensee shall provide care and supervision as necessary to meet the children's needs. Supervision shall include visual observation.

This requirement was not met as evidenced by:
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Lead Teacher agrees to provide training in providing care and supervision, including visual observation to children in care. Training shall include staff watching video offered through the Department's website;

https://ccld.childcarevideos.org/
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Staff interviewed admitting to no one observing Child #1 fall over 5 1/2 feet to the ground from a platform of a climbing structure.



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The plan of correction shall include a copy of the sign-in sheet of staff who were provided training and a written statement on how staff will apply information provided in video.

The plan of correction shall be submitted to CCLD on or before 7/25/2019.
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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: Laura ChavezTELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2019
LIC809 (FAS) - (06/04)
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