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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 475402239
Report Date: 06/06/2024
Date Signed: 06/06/2024 01:17:37 PM

Document Has Been Signed on 06/06/2024 01:17 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-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:SISKIYOU (SCOE) PRESCHOOLFACILITY NUMBER:
475402239
ADMINISTRATOR/
DIRECTOR:		SIMAS, J.FACILITY TYPE:
850
ADDRESS:1 CHILD'S WAYTELEPHONE:
(530) 842-8405
CITY:YREKASTATE: CAZIP CODE:
96097
CAPACITY: 42TOTAL ENROLLED CHILDREN: 18CENSUS: 17DATE:
06/06/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:40 AM
MET WITH:Amanda ElsemoreTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
NARRATIVE
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On 6/6/24 @ 11:30am, an inspection was conducted by Licensing Program Analyst (LPA) Nicolette Cunningham in response to an unusual incident that was self-reported by the administrative secretary. Community Care Licensing Division (CCLD) was notified within 24 hours and unusual incident report was sent in writing within the 7 days as required. The incident occurred on 6/3/24 at approximately 10:30am when children and staff transitioned from the classroom to the outside play area. The school secretary reported that the incident occurred when Staff 1 left to pick up lunch from the school cafeteria. While on the playground, Staff 2 noticed three children (C1-C3) were missing from the group of 14 children. Staff 2 went to look for the children and found C1 in the bathroom and C2 and C3 outside close to the parking lot behind a tree. C2 and C3 were outside the fenced area which is approximately five to ten feet from the parking lot. LPA photographed the two areas the children were found (photograph 1 & 2). Staff estimate the children were without supervision for less than five minutes.

The following violation of the California Code of Regulations, Tittle 22: Division 12 was observed: Absence of supervision resulting in two children wandering outside. see LIC 809D.

*Continued on 809D

SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Nicolette Cunningham
LICENSING EVALUATOR SIGNATURE: DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/06/2024
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
CHICO-DAY CARE, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: SISKIYOU (SCOE) PRESCHOOL
FACILITY NUMBER: 475402239
VISIT DATE: 06/06/2024
NARRATIVE
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LPA Cunningham informed the facility representative Amanda Elsemore that this report dated 6/6/24 documents one Type A citation which shall be posted for 30 consecutive days as there is an immediate risk to the health, safety, or personal rights of children in care.

Also, LPA Cunningham informed the facility representative to provide a copy of this licensing report dated 6/6/24 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.


Exit interview conducted and report was reviewed with the administrative secretary. A notice of site visit was given and must remain posted for 30 days. Appeal rights were provided. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Nicolette Cunningham
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/06/2024 01:17 PM - It Cannot Be Edited


Created By: Nicolette Cunningham On 06/06/2024 at 12:40 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: SISKIYOU (SCOE) PRESCHOOL
FACILITY NUMBER: 475402239

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/06/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/07/2024
Section Cited
CCR
101229(a)(1)

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(a) The licensee shall provide care and supervision as necessary to meet the children's needs. (1) No child(ren) shall be left without the supervision of a teacher at any time, except as specified in Sections 101216.2(e)(1) and 101230(c)(1). Supervision shall include visual observation.
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The administrative secretary stated door chimes were placed doors leading to the classroom. Staff discussed staying with adults, not running through the building, and not running in the parking lot. Staff had a meeting on 6/4/24 and discussed steps to prevent future incidents.
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Based on interviews, the facility did not comply with the section cited above, which poses an immediate health, safety or personal rights risk to children in care.
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The administrative secretary stated she will e-mail meeting notes to LPA by 6/7/24.

nicolette.cunningham@dss.ca.gov

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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:Erin Virrueta
LICENSING EVALUATOR NAME:Nicolette Cunningham
LICENSING EVALUATOR SIGNATURE:
DATE: 06/06/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/06/2024


LIC809 (FAS) - (06/04)
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