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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 123005885
Report Date: 07/03/2019
Date Signed: 07/03/2019 01:01:15 PM

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:CHILDREN OF THE REDWOODS INFANT TODDLER CENTERFACILITY NUMBER:
123005885
ADMINISTRATOR:BEAUCHEMIN, MICHAELAFACILITY TYPE:
830
ADDRESS:3609 SPEAR AVENUETELEPHONE:
(707) 822-8020
CITY:ARCATASTATE: CAZIP CODE:
95521
CAPACITY:20CENSUS: 11DATE:
07/03/2019
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Laura WyrickTIME COMPLETED:
01:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Kiriko Lynch visited the facility today and met with Center Director for a case management - deficiency.

Interviews revealed the facility had an ongoing outbreak of hand, foot, and mouth for approximately one week, and had not reported the incident to Licensing per regulatory requirements. LPA discussed center reporting requirements, and also regulatory timeframes for reporting incidents to Licensing with the Director. An exit interview was conducted, appeal rights provided, and Notice of Site visit was posted.

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: 07/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2019
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
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: CHILDREN OF THE REDWOODS INFANT TODDLER CENTER
FACILITY NUMBER: 123005885
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/03/2019
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/10/2019
Section Cited
CCR
101212
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Reporting Requirements
(d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours.
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Director stated she understands regulatory requirements for center reporting requirments, and will review requirements and implement or modify policies as needed, and send a written statement to Licensing verifying policies and that she understands and will follow the specified requirements in the future.
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In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event.
(1) Events reported shall include the following:...
(E) Epidemic outbreaks.
Facility did not report outbreak per regulatory requirments.
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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: 07/03/2019
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2019
LIC809 (FAS) - (06/04)
Page: 2 of 2