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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 115400726
Report Date: 09/18/2024
Date Signed: 09/18/2024 02:59:05 PM


Document Has Been Signed on 09/18/2024 02:59 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 CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926



FACILITY NAME:CHAPMAN STREET HEAD START A-B-CFACILITY NUMBER:
115400726
ADMINISTRATOR:SILVIA C/KINKLE S/FRIAS AFACILITY TYPE:
850
ADDRESS:124 E. CHAPMAN STREETTELEPHONE:
(530) 865-1143
CITY:ORLANDSTATE: CAZIP CODE:
95963
CAPACITY:60CENSUS: DATE:
09/18/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:17 PM
MET WITH:Wendi CallanTIME COMPLETED:
03:15 PM
NARRATIVE
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An unannounced follow up case management inspection was conducted in response to a case management inspection on 09/11//24 today at 2:17pm by Licensing Program Analyst (LPA), Tammy Dutra. LPA met with facility representative and interviewed S1-S4 regarding the incident in response to an Unusual Incident Report received by the Department on 9/5/24, where a child was left on the playground after outdoor play.

The staff was interviewed on 9/11/24 and stated that on 9/5/24 C1 was left on the playground. Staff miscounted the children in care when returning from outdoor play and C1 was outside sitting at the picnic table. Staff indicated the child was located in 1-2 minutes and their parent was notified of the incident.

C1’s parent was interviewed on 9/18/24 and indicated they was informed of the incident immediately and did not have safety concerns for their child in care.

Based on report received and interviews conducted the following deficiency is being cited on the LIC809-D: 101229(a)(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.

SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 966-0216
LICENSING EVALUATOR NAME: Tammy DutraTELEPHONE: (530) 806-3471
LICENSING EVALUATOR SIGNATURE:
DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/18/2024
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 CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: CHAPMAN STREET HEAD START A-B-C
FACILITY NUMBER: 115400726
VISIT DATE: 09/18/2024
NARRATIVE
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LPA informed facility Representative Wendi Callan that this report dated 9/18/24 documents one Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.
LPA Tammy Dutra informed the facility representative to provide a copy of this licensing report dated 9/18/24 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

During today’s inspection, the facility was toured, and LPA observed 11 children in care.

Exit interview conducted and report was reviewed with the facility representative Wendi Callan.

Appeal rights were provided.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 966-0216
LICENSING EVALUATOR NAME: Tammy DutraTELEPHONE: (530) 806-3471
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/18/2024 02:59 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 CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926


FACILITY NAME: CHAPMAN STREET HEAD START A-B-C
FACILITY NUMBER: 115400726

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/18/2024
Section Cited
CCR
101229(a)(1)

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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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Facility has implemented training to readress their current protocols. They implemented site specific trainings around current facility site. Playground sweeps are being done at each transition to ensure head count protocols are being followed.
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Based on record review the licensee did not comply with the section cited C1 was left unsupervised on the play ground , which poses an immediate health, safety, or personal rights risk to children in care.

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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) 966-0216
LICENSING EVALUATOR NAME: Tammy DutraTELEPHONE: (530) 806-3471
LICENSING EVALUATOR SIGNATURE:
DATE: 09/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/18/2024
LIC809 (FAS) - (06/04)
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