525400269-4-18-2024-13-CC-BMEZ-D4FRFQ-20240418125931

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 525400269
Report Date: 04/18/2024
Date Signed: 04/18/2024 12:59:38 PM

Document Has Been Signed on 04/18/2024 12:59 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
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME:	CORNING HEAD START CENTER		FACILITY NUMBER:	525400269
ADMINISTRATOR:	CURIEL, LAURA		FACILITY TYPE:	850
ADDRESS:	617 FIG LANE		TELEPHONE:	(530) 838-1034
CITY:	CORNING	STATE: CA	ZIP CODE:	96021
CAPACITY:	24	CENSUS: 15	DATE:	04/18/2024
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	11:24 AM
MET WITH:	Laura Curiel		TIME COMPLETED:	01:10 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 11:24am by Licensing Program Analyst (LPA), Bianca Mendez. LPA met with facility representative Laura Curiel. In response to an Unusual Incident Report received by the Department on 4/17/24. The incident occurred on 4/16/24, Child (C1) was walking toward the wooden ledge of the playground and tripped on their own feet and landed on their shoulder and broke their collarbone. Facility representative was interviewed on 4/18/24 at 11:29am and stated they did not witness the incident but were aware that on 4/16/24 at 3:25pm while there were 10 children outside on the playground and 2 staff present with the children, C1 had stepped on the wooden ledge of the playground box and had tripped on their own foot and had landed on their shoulder. S1 stated that they had witnessed the incident and stated that C1 was talking to S1 and had stepped on the the wood ledge of the playground, C1 put one foot in front of the other and tripped and C1 landed on their left arm. S1 stated that C1 was crying and had picked them up. S1 stated that they had C1 lift their arms up and had C1 put their arm down and C1 told them that their eczema hurt. S1 stated they did not observe any visible marks and sat with C1 for 5 minutes and then S2 sat with C1.

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Bianca Mendez	TELEPHONE: (530) 895-4357
LICENSING EVALUATOR SIGNATURE:	DATE: 04/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024

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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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: CORNING HEAD START CENTER	FACILITY NUMBER: 525400269
	VISIT DATE: 04/18/2024

NARRATIVE

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S2 was interviewed on 4/18/24 stated that they were sitting on the long bench outside in the playground and had seen that S1 was standing there on the boxed part of the playground and saw that C1 trip over their foot walking toward the wooden ledge and fell and landed on their collarbone. S2 stated that S1 comforted C1 and then S2 comforted C1. S1 and S2 stated that the incident happened before pick up.
S3 was interviewed on 4/18/24 and stated they did not witness the incident. S3 stated they were inside and walking outside and witnessed S1 comforting C1 outside and checking for marks.

LPA interviewed parent (P1) on 4/18/24 at 11:52am and stated that the incident happened before (P2) picked up C1. P1 stated that they heard from P2 that C1 lost their balance and landed on their shoulder and rolled over and landed on their collarbone. P1 stated they have no concerns regarding supervision.

During today’s inspection, the facility was toured. LPA observed 3 staff and 15 children in care. LPA took a photo of the children's playground from where the incident occurred.

Based on observations and staff interviews, it could not be determined the serious injury occurred due to lack of supervision.

There were no deficiencies cited during today’s inspection. A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with facility representative

SUPERVISOR'S NAME: Megan Aviles	TELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Bianca Mendez	TELEPHONE: (530) 895-4357
LICENSING EVALUATOR SIGNATURE:	DATE: 04/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2024

LIC809 (FAS) - (06/04)

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