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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 181372519
Report Date: 02/12/2025
Date Signed: 02/12/2025 12:25:43 PM

Document Has Been Signed on 02/12/2025 12:25 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:SUSANVILLE HEAD STARTFACILITY NUMBER:
181372519
ADMINISTRATOR/
DIRECTOR:		SWAIN, NICOLETTEFACILITY TYPE:
850
ADDRESS:195 RUSSELL AVETELEPHONE:
(530) 257-2343
CITY:SUSANVILLESTATE: CAZIP CODE:
96130
CAPACITY: 28TOTAL ENROLLED CHILDREN: 28CENSUS: 23DATE:
02/12/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:32 AM
MET WITH:Nicolette Swain - Director TIME VISIT/
INSPECTION COMPLETED:
12:35 PM
NARRATIVE
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An unannounced case management inspection was conducted in response to an unusual incident report on 02/12/25 today at 10:32pm by Licensing Program Analyst (LPA), Sydney Sims and Emily Curiel. LPAs met with Director Nicolette Swain, in response to an Unusual Incident Report received by the Department on 1/23/25, where a child (C1) was left on the playground during transition.

The Director was interviewed on 02/12/25 at 10:56am and stated that on 01/23/25 Child C1 was left outside alone on the play ground for approximately 1 minute during transition, but that teachers on the adjacent playground observed C1 and brought C1 back inside. Director stated all facility staff have reviewed and signed the active supervision policy in response to this incident.

Three Staff (S1 - S3) were interviewed on 02/12/25 and stated that C1 was left outside on the play ground for approximately one minute, C1 was heard crying by staff S2 on the adjacent playground, S3 then went and took C1 into the classroom.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Sydney Sims
LICENSING EVALUATOR SIGNATURE: DATE: 02/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/12/2025
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
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: SUSANVILLE HEAD START
FACILITY NUMBER: 181372519
VISIT DATE: 02/12/2025
NARRATIVE
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LPA Sims observed camera footage from 1/23/25 and observed that child C1 was left outside at 11:14:50am and was brought inside by staff S3 at 11:15:36am.

During today’s inspection, the facility was toured and LPAs observed 23 children in care.

Based on information reported and interview conducted the following deficiency is being cited on the LIC809-D: 101229(a)(1) No child(ren) shall be left without the supervision of a teacher at any time.

Exit interview conducted and report was reviewed with the Director Nicolette Swain appeal rights were provided.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Sydney Sims
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/12/2025 12:25 PM - It Cannot Be Edited


Created By: Sydney Sims On 02/12/2025 at 12:13 PM
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: SUSANVILLE HEAD START
FACILITY NUMBER: 181372519

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/12/2025
Section Cited
CCR
101229(a)(1)

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No child(ren) shall be left without the supervision of a teacher at any time...

This requirement was not met as evidence by:
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Facility staff will review and sign active supervison policy during staff meeting. Director will provide LPA Sims with a copy of the active sueprvision policy signed by staff by 03/12/25
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Based on information reported and interview conducted the facility did not comply with the section cited above in 1 count of leaving a child unsupervised.
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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:Sydney Sims
LICENSING EVALUATOR SIGNATURE:
DATE: 02/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/12/2025


LIC809 (FAS) - (06/04)
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