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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455407425
Report Date: 05/21/2019
Date Signed: 05/21/2019 01:36:41 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:BUCKEYE SDC PRESCHOOLFACILITY NUMBER:
455407425
ADMINISTRATOR:LYNN MAXWELLFACILITY TYPE:
850
ADDRESS:3499 HIATT DRIVETELEPHONE:
(530) 225-0411
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY:15CENSUS: 6DATE:
05/21/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Lynn MaxwellTIME COMPLETED:
01:45 PM
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 A follow up case management inspection was made to this facility by Licensing Program Analyst (LPA) Snow. LPA met with the Lead teacher/ Lynn Maxwell. The facility self-reported, in a timely manner, an incident of a child injury that occurred on 4/22/19. The child was being monitored one-on-one and displayed a self injurious behaviors which resulted in a broken nose. The LPA conducted interviews with S-1, S-2 & S-3 who were present when the injury occurred and they were all consistent with the written reports. The Individualized Education Program (IEP) and other file documents for the child C-4 were reviewed and no violations of Title 22 were observed.

All licensing reports are public information and must be made available upon request for at least three years. This report was read and discussed with the Lead Teacher.
Notice of Site Visit shall be posted for 30 days from today's visit.
There were no Title 22 deficiencies cited during today's inspection.
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Jaime SnowTELEPHONE: (530) 215-6132
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2019
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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