<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455403966
Report Date: 05/10/2024
Date Signed: 05/10/2024 01:12:36 PM


Document Has Been Signed on 05/10/2024 01:12 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 CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926



FACILITY NAME:KINDERLAND CHILD DEVELOPMENT CENTERFACILITY NUMBER:
455403966
ADMINISTRATOR:WILSON, SUSANFACILITY TYPE:
850
ADDRESS:1630 VICTORTELEPHONE:
(530) 223-6161
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY:53CENSUS: 10DATE:
05/10/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Susan Wilson - Director TIME COMPLETED:
01:22 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
An unannounced case management inspection was conducted today at 12:10pm by Licensing Program Analyst (LPA), Sydney Sims and Tammy Dutra. LPA met with Licensee Susan Wilson . In response to an Unusual Incident Report received by the Department on 4/16/24, where a child sustained dislocated elbow while in care.

The facility representative was interviewed on 5/10/24 at 12:48pm and stated that on 4/16/24 child C1's behavior was very severe and C1's parents were called to pick up C1 from the facility. Licensee stated that S2 was the staff present for the incident and that S2 was holding C1's hand and C1 threw themselves backwards. S2 tried to keep C1 from hitting their head, and S1 was still holding C1's hand and then C1's elbow dislocated.

One Child (C1) was interviewed on 5/10/24 and stated that staff S2 grabbed C1's arm and bent it back hard.
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Sydney SimsTELEPHONE: (916) 365-5731
LICENSING EVALUATOR SIGNATURE:
DATE: 05/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/10/2024
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
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: KINDERLAND CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 455403966
VISIT DATE: 05/10/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
One staff (S1) was interviewed on 5/10/24, S1 stated that S1 was present for the incident and that C1's behavior was particularly difficult that day and C1's parents were called to pick C1 up. S1 stated that the incident was an accident and S2 was trying to prevent C1 from hitting their head.

During today’s inspection, the facility was toured and LPAs observed 10 children in care.

LPAs requested a copy of the facility roster, Personnel Roster, Incident reports and behaviors charts for C1.

Based on information gathered further investigation is needed.

Exit interview conducted and report was reviewed with the licensee Susan Wilson. Appeal Rights were provided.
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Sydney SimsTELEPHONE: (916) 365-5731
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2