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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 081373630
Report Date: 09/26/2019
Date Signed: 09/26/2019 01:46:32 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:JOE HAMILTON STATE PRESCHOOLFACILITY NUMBER:
081373630
ADMINISTRATOR:HARDEN, DENISEFACILITY TYPE:
850
ADDRESS:1050 E STREETTELEPHONE:
(707) 464-0330
CITY:CRESCENT CITYSTATE: CAZIP CODE:
95531
CAPACITY:24CENSUS: 12DATE:
09/26/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Melinda PearceyTIME COMPLETED:
02:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Kiriko Lynch visited the facility today for the purpose of a case management incident investigation for a self-reported incident.

The incident was self-reported by the facility immediately after the incident, and was reported to Licensing on 09/13/19. LPA Lynch met with Acting Lead Teacher Melinda Pearcey, toured the facility, and interviewed staff regarding the incident. Lead Teacher stated that a preschool child opened a gate near the facility building, and ran out to the facility parking lot. She stated the Lead teacher that day turned around, saw the child running past the toy shed near the gate, and immediately ran after the child and brought the child back to the facility. Interviews with staff revealed gate had previously been locked and latched, but wasn't latched or locked at the time of the incident due to no latch or lock available to staff.

A child was able to exit the fenced play area and to an unfenced parking area. The incident was self-reported by the Acting Program Director, the facility staff was forthcoming about the incident, and the program has recently installed a latch on the gate; however, this still constitutes an immediate risk to the children in care as evidenced by the initial incident report. Reports citing Type A violations are to be provided to parents/guardians of children currently enrolled and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC 9224 and a copy is to be kept in each child's file at the facility.

This report was reviewed and discussed with the Acting Lead Teacher, and a plan of correction was discussed. All Licensing reports are public information and must be made available upon request for at least three years. Appeal Rights were provided.

See next page for deficiency cited.
Notice of Site Visit shall be posted for 30 days from today's visit.
SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Kiriko LynchTELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2019
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: JOE HAMILTON STATE PRESCHOOL
FACILITY NUMBER: 081373630
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/26/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/27/2019
Section Cited

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Responsibility for Providing Care and Supervision
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(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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Child was able to exit the facility via an unlatched/unlocked gate that had previously been latched/locked.
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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: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Kiriko LynchTELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:
DATE: 09/26/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/26/2019
LIC809 (FAS) - (06/04)
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