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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045407980
Report Date: 06/08/2022
Date Signed: 06/08/2022 09:54:27 AM

Document Has Been Signed on 06/08/2022 09:54 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:CREATIVE SCHOLARS ACADEMY PRESCHOOLFACILITY NUMBER:
045407980
ADMINISTRATOR:RAY, NICOLEFACILITY TYPE:
850
ADDRESS:120 YELLOWSTONE DR.TELEPHONE:
(530) 809-2468
CITY:CHICOSTATE: CAZIP CODE:
95973
CAPACITY: 58TOTAL ENROLLED CHILDREN: 58CENSUS: 28DATE:
06/08/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:39 AM
MET WITH:Lauren ThompsonTIME COMPLETED:
09:53 AM
NARRATIVE
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During an inspection at the facility it was determined that the licensee/director failed to report an unusual incident on 2/9/22 to Community Care Licensing Division as required. Previously the licensee/director stated that the incident was not reported to CCLD as they were uncertain if the alleged incident needed to be reported. Licensee/director previously communicated incident with parent and felt that the information was sufficient. Though it is unknown if the actual incident occurred or not, regulation and it is required to report of any suspected incidents of physical or psychological abuse of any child, which includes any suspected child on child abuse. Further, a verbal declaration by a child in care of child on child abuse should be an unusual incident in and of itself.

This report was reviewed and discussed with the director Lauren Thompson

The following deficiency of the California Code of Regulations, Title 22; Division 12, was observed: see LIC 809D. Appeal Rights were provided. The Notice of Site Visit shall be posted for 30 days.

SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Bianca Mendez
LICENSING EVALUATOR SIGNATURE: DATE: 06/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/08/2022
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 06/08/2022 09:54 AM - It Cannot Be Edited


Created By: Bianca Mendez On 06/08/2022 at 09:42 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 520 COHASSET RD., SUITE 170
CHICO, CA 95926

FACILITY NAME: CREATIVE SCHOLARS ACADEMY PRESCHOOL
FACILITY NUMBER: 045407980

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/08/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/08/2022
Section Cited
CCR
101212(d)(1)(c)

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Reporting requirements
Upon the occurrence, during the operation of the childcare center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event. Events reported shall include the following: Any unusual incident or child absence that threatens the physical or emotional health or safety of any child.
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The license/director agreed to review section 101212 of Title 22 California Code of Regulations. The licensee agreed to review the section and send an acknowledgment to CCLD and review child care videos by 6/17/21.
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This requirement was not met as evidenced by:
Licensee failed to report an unusual incident that occurred on 2/9/22 that resulted in a child sustaining an injury at the time.
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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 Aviles
LICENSING EVALUATOR NAME:Bianca Mendez
LICENSING EVALUATOR SIGNATURE:
DATE: 06/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/08/2022


LIC809 (FAS) - (06/04)
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