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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 121305613
Report Date: 03/15/2023
Date Signed: 03/15/2023 05:19:43 PM


Document Has Been Signed on 03/15/2023 05:19 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-DAY CARE, 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:
03/15/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Elizabeth "Betsy" WilsonTIME COMPLETED:
05:30 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 03/09/22 when it happened. Center Director stated a preschool child was able to leave the classroom restroom unattended during a transition period. and went outside into the fenced playground and was unsupervised for approximately two to five minutes. She stated an infant teacher saw the child outside while transitioning and brought her inside to the preschool to the lead teacher. She stated the child's parents were informed and spoken to by Center Director immediately after the incident. She stated child is currently back in care at the facility and Center Director has implemented new preventative measures including restroom door alarm installation and staff supervision training within two weeks of the incident. LPA also observed area where the incident happened and conducted an interview with a witness regarding the incident. Exit interview conducted, appeal rights provided, Notice of Site Visit posted. See next page for deficiency cited.
SUPERVISOR'S NAME: Erin VirruetaTELEPHONE: (530) 966-0216
LICENSING EVALUATOR NAME: Kiriko LynchTELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:
DATE: 03/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/15/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 03/15/2023 05:19 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-DAY CARE, 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: 03/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/29/2023
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.
(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)
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Center Director stated she has spoken with the child's family, involved teachers, and her management regarding the incident. She stated door alarm has been installed on the restroom door, and LPA observed it at the time of the visit, She stated a supervision refresher training will be held next week for all staff.
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and 101230(c)
(1) Supervision shall include visual observation. This requirement was not met as evidenced by a child was able to leave the classroom restroom into a fenced playground area without a teacher. Facility self reported the incident same day to Licensing.
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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: Kiriko LynchTELEPHONE: (530) 895-5033
LICENSING EVALUATOR SIGNATURE:
DATE: 03/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/15/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2