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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313621208
Report Date: 01/30/2020
Date Signed: 01/30/2020 11:08:49 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:SMART START AUBURNFACILITY NUMBER:
313621208
ADMINISTRATOR:BOOTH, SHANNAHFACILITY TYPE:
850
ADDRESS:1273 HIGH STREETTELEPHONE:
(916) 303-0851
CITY:AUBURNSTATE: CAZIP CODE:
95603
CAPACITY:130CENSUS: 44DATE:
01/30/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Shannah BoothTIME COMPLETED:
11:30 AM
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Licensing Program Analysts Lea Habtom and Amanda Blesi met with director Shannah Booth to follow up on an incident that occurred on December 9, 2019 which the facility self reported.

A census was taken which included 44 preschool children supervised by 4 staff.

LPA's interviewed director Shannah Booth who stated she held child by the hand who was walking behind her when she asked the child to clean up the mess. The child refused to clean up the mess and threw themself to the ground. The Director held on to the child's hand to avoid the child from hitting the back of child's head. The director stated she let go of the child's hand after the fell. Director states child complained of wrist pain which then the director notified the parent of the injury. Child remained in care until lunch and was observed a few times throughout the day in which the child complained about the wrist hurting. Child was picked up around noon by grandparents.

The next day the director was notified by the parents the child had received medical attention for a dislocated elbow.

Based on information available LPA's concluded that there were no title 22 violations.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Lea HabtomTELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2020
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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