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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 121305613
Report Date: 08/11/2022
Date Signed: 08/11/2022 04:15:57 PM


Document Has Been Signed on 08/11/2022 04:15 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
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926



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: 17DATE:
08/11/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Elizabeth "Betsy" WilsonTIME COMPLETED:
04:30 PM
NARRATIVE
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LPA Lynch visited the facility for the purpose of a case management incident which was self-reported by the facility to Licensing on 06/17/22 when it happened. Center Director stated a child was able to leave the classroom unattended and went through the hallway into the fenced outside playground area and was unsupervised for approximately two minutes close to pickup time. She stated a parent saw the child outside while picking up their child and informed facility staff the child was outside. She stated the child was playing at the mud kitchen outside and was brought inside by facility staff, and was unharmed and not upset. She stated the child's parents were informed and spoken to regarding the incident by Center Director. She stated child is currently back in care at the facility and Center Director has implemented new preventative measures including safety equipment installation and staff supervision training within a week of the incident. LPA also observed area where the incident happened and conducted an interview with a witness in regards to the incident. See next page for deficiency cited.
SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 895-4325
LICENSING EVALUATOR NAME: Kiriko LynchTELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:
DATE: 08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/11/2022
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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Document Has Been Signed on 08/11/2022 04:15 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
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: 08/11/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/12/2022
Section Cited

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Responsibility for Providing Care and Supervision

(a) The licensee shall provide care and supervision as necessary to meet the children's needs.
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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. This requirement was not met by a child was able to leave the classroom into a fenced playground area without a teacher. Facility self-reported the incident to Licensing.
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awareness. She stated door knobs were also ordered and replaced to accommodate child safety equipment. She stated all work was done within a week of the incident. She stated all classrooms will be implementing their EHS active supervision plans. POC cleared at the time of visit.

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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: 08/11/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/11/2022
LIC809 (FAS) - (06/04)
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