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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455401376
Report Date: 06/29/2023
Date Signed: 06/29/2023 10:09:56 AM


Document Has Been Signed on 06/29/2023 10:09 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:SHASTA HEAD START - ANDERSON PARK CENTERFACILITY NUMBER:
455401376
ADMINISTRATOR:MILLER, SUSANFACILITY TYPE:
850
ADDRESS:1600 VETERANS LANETELEPHONE:
(530) 245-5118
CITY:ANDERSONSTATE: CAZIP CODE:
96007
CAPACITY:56CENSUS: 7DATE:
06/29/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:44 AM
MET WITH:Suzanne MillerTIME COMPLETED:
10:15 AM
NARRATIVE
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On 6/29/23 at 8:44am a visit was conducted by Licensing Program Analyst's (LPA) Mendez in response to an unusual incident that was self reported in a timely manner by Suzanne Miller, facility director. The incident occurred on 6/20/23 at approximately 9:58 am. Community Care Licensing Division (CCLD) was notified within 24 hours and unusual incident report was sent in writing within the 7 days as required. Facility director reported that three children had walked out on the playground without supervision from their teacher.

LPA Mendez conducted an interview with facility director Suzanne Miller at approximately 8:44am who stated on 6/20/23 @ 9:58am four teachers were supervising 10 children in the classroom and 3 children (C1-C3) from the 3 year old classroom had went outside without supervision from their teacher. At the time there was another classroom outside with teachers and 4 year olds from the 4 year old classroom.

LPA Mendez reviewed the camera footage that was consistent with the statement in the unusual incident report that children were left unsupervised for 30 seconds.

The facility was toured inside and outside and LPA observed 7 children in care.

The following violation of the California Code of Regulations, Tittle 22: Division 12 was observed: Lack of supervision resulting in children wandering outside. see LIC 809D.

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

SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Bianca MendezTELEPHONE: (530) 895-4357
LICENSING EVALUATOR SIGNATURE:
DATE: 06/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/29/2023
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 06/29/2023 10:09 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: SHASTA HEAD START - ANDERSON PARK CENTER
FACILITY NUMBER: 455401376

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/29/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/29/2023
Section Cited
CCR
101229(a)(1)

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(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) and 101230(c)(1). Supervision shall include visual observation.
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Facility director and area manager issued individual staff meetings and staff were issued write-ups on 6/27/23. Two staff members must do verbal head counts during transition and rezoning each area and have visual on children. Director to submit a plan in writing to CCL by 6/30/23
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This was not met as evidence by: based on interviews and record review, C1, C2 and C3 were unsupervised for 30 seconds on the playground. This poses an potential health, safety, or personal rights risk to persons in care.
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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 AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Bianca MendezTELEPHONE: (530) 895-4357
LICENSING EVALUATOR SIGNATURE:
DATE: 06/29/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/29/2023
LIC809 (FAS) - (06/04)
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