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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 121305613
Report Date: 09/07/2021
Date Signed: 09/07/2021 04:46:07 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/18/2021 and conducted by Evaluator Kiriko Lynch
PUBLIC
COMPLAINT CONTROL NUMBER: 13-CC-20210818133626
FACILITY NAME:HSU CHILDREN'S CENTER - PRESCHOOLFACILITY NUMBER:
121305613
ADMINISTRATOR:ELIZABETH WILSONFACILITY TYPE:
850
ADDRESS:HSU-MARY WARREN HOUSE 36TELEPHONE:
(707) 826-4982
CITY:ARCATASTATE: CAZIP CODE:
95521
CAPACITY:58CENSUS: 13DATE:
09/07/2021
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Betsy WilsonTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Staff did not seek medical attention for a child's injury

Staff did not report an injury to the child's authorized representative
INVESTIGATION FINDINGS:
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On 09/07/21, an opening complaint investigation visit was made to the facility by LPA Lynch. It has been alleged that staff did not seek medical attention for a child's injury, and staff did not seek medical attention for a child's injury. LPA met with the Center Director, conducted an interview, and discussed the allegations. Center Director was forthcoming about the incident, and stated the staff did not follow center injury procedures and reporting requirements to the child's parents regarding the injury. During the investigation, LPA also toured facilty and observed the area in question, and also reviewed records and documentation related to the allegations. Based on the evidence obtained, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. TYPE A - The following violation of the California Code of Regulations, Title 22, Division 12, was cited: see LIC 9099-D. Reports citing Type A violations are to be provided to parents/guardians of children currently in enrolled, and to parents/guardians of children newly enrolled at the facility during the next 12 months. Parents/guardians must sign Form LIC 9224 to be kept in each child's file. Appeal rights were provided and exit interview conducted. Notice of Site Visit shall be posted for 30 days from today’s visit. All licensing reports are public information and must be made available upon request for at least three years.
Substantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Kiriko LynchTELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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Control Number 13-CC-20210818133626
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: HSU CHILDREN'S CENTER - PRESCHOOL
FACILITY NUMBER: 121305613
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/07/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/08/0101
Section Cited
CCR
101226
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Health-Related Services
(a) The licensee shall immediately notify the child's authorized representative if the child becomes ill or sustains an injury more serious than a minor cut or scratch. The licensee shall obtain specific instructions from the authorized representative regarding action to be taken.
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Center Director stated she held a staff training regarding injury procedures and reporting requirements the same week of the incident, and will provide staff signed training documentation to Licensing by POC due date.
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(b) The licensee shall make prompt arrangements for obtaining medical treatment for any child if necessary.
Based on interviews and records, the licensee did not comply regarding injury procedures and reporting requirements which poses an immediate health,safety or personal rights risk to persons 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) 895-4325
LICENSING EVALUATOR NAME: Kiriko LynchTELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:

DATE: 09/07/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2021
LIC9099 (FAS) - (06/04)
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