185405669-7-14-2022-13-CC-CWIT-CGBMXF-20220714095952

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 185405669
Report Date: 07/14/2022
Date Signed: 07/14/2022 09:59:58 AM

Document Has Been Signed on 07/14/2022 09:59 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
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME:	JUST KIDDING AROUND		FACILITY NUMBER:	185405669
ADMINISTRATOR:	FURTADO, LORI		FACILITY TYPE:	850
ADDRESS:	655 ASH STREET		TELEPHONE:	(530) 257-0303
CITY:	SUSANVILLE	STATE: CA	ZIP CODE:	96130
CAPACITY:	29	CENSUS: 0	DATE:	07/14/2022
TYPE OF VISIT:	Case Management - Deficiencies	UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Georgina Johnson		TIME COMPLETED:	10:10 AM

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On 7/14/22 at 9:40 am Licensing Program Analyst (LPA) Carrie Wisehart conducted a Case Management visit and met with Georgina Johnson to discuss reporting requirements to include calling the office within 24 hours and then following up with a written report within 7 days.

S1 was made aware of an incident on 4/11/22 that occurred between C1 and C2 which affected the physical and emotional health and safety of C2, however S1 did not feel the incident was reportable having not witnessed it and therefore, the staff never called the incident in to CCL and the written report was not completed until 4/25/22 which is past the 7 day requirement.

Notice of Site Visit shall be posted for 30 days from today's visit.

The following violation(s) of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal Rights were provided.

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Carrie Wisehart	TELEPHONE: (530) 895-5824
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022

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 07/14/2022 09:59 AM - 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: JUST KIDDING AROUND	FACILITY NUMBER: 185405669
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/14/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/04/2022 Section Cited	1 2 3 4 5 6 7	101212 (d)(1)(C) Reporting Requirements –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. 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.
	8 9 10 11 12 13 14	Events reported shall include the following: Any unusual incident or child absence that threatens the physical or emotional health or safety of any child.This requirement was not met as evidenced by: Based on interviews and record review S1 was aware of an incident on 4/11 but did not call it in to the Department and did not submit a written incident report timely as required. This poses a potential health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14
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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: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Carrie Wisehart	TELEPHONE: (530) 895-5824
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022

LIC809 (FAS) - (06/04)

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