115405947-5-8-2024-13-CC-SSIS-D53N2M-20240508100459

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 115405947
Report Date: 05/08/2024
Date Signed: 05/08/2024 10:05:05 AM

Document Has Been Signed on 05/08/2024 10:05 AM - 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:	VILLA AVENUE HEAD START		FACILITY NUMBER:	115405947
ADMINISTRATOR:	AISENBREY, JANICE		FACILITY TYPE:	850
ADDRESS:	451 S. VILLA AVENUE		TELEPHONE:	(530) 934-6596
CITY:	WILLOWS	STATE: CA	ZIP CODE:	95988
CAPACITY:	20	CENSUS: 14	DATE:	05/08/2024
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Naomi Suarez - Director		TIME COMPLETED:	10:15 AM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	An unannounced case management inspection was conducted today at 9:00 am by Licensing Program Analyst (LPA), Sydney Sims and Tammy Dutra. LPAs met with facility representative Naomi Suarez. In response to an Unusual Incident Report received by the Department on 4/9/24 where a child (C1) who was swinging on the bars of a play ground set slipped and hit their head and received 3 staples. The facility representative was interviewed on 5/8/24 at 9:27am and stated that on 4/8/24 at 1:45pm child C1 was outside playing on the play structure and was swinging on the the bars above the stairs, C1 was told multiple times to stop swinging but would not stop. Facility representative stated that the child was under the supervision on at least four teachers. Two staff were interviewed on 5/8/24 and S1- S2 stated that C1 was under the supervision of four to five teachers and was told to stop swinging on the bars but did not stop swinging resulting in C1 falling and hitting their head. One Child (C1) was interviewed on 5/8/24 and C1 stated that C1 was swinging on the bars on the play structure and slipped off the bars. C1 stated that there was multiple teachers and children present during the time of the incident.

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Sydney Sims	TELEPHONE: (916) 365-5731
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024

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: VILLA AVENUE HEAD START	FACILITY NUMBER: 115405947
	VISIT DATE: 05/08/2024

NARRATIVE

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One Parent (P1) was interviewed on 5/8/24 and P1 stated that P1 believes that the incident could not have been prevented. P1 stated that P1 has no concerns with the supervision or safety of C1

During today’s inspection, the facility was toured LPA observed 14 children in care

There were no deficiencies cited during today’s inspection. A notice of site visit was given and must remain posted for 30 days.

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

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Sydney Sims	TELEPHONE: (916) 365-5731
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2024

LIC809 (FAS) - (06/04)

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