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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525407977
Report Date: 07/30/2024
Date Signed: 08/13/2024 02:09:16 PM


Document Has Been Signed on 08/13/2024 02:09 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 08/07/2024 08:24 AM

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

NARRATIVE
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An unannounced case management inspection was conducted 7/30/24 at 8:13am and again on 8/7/24 by Licensing Program Analyst (LPA), Sydney Sims and Kayla Danielson. LPAs met with Director Jessie Radcliff. In response to an Unusual Incident Report received by the Department on 7/29/24, where a staff had pinched child C1 and grabbed child C2 by the shoulders.

The Director was interviewed on 7/30/24 at 8:13am and 8/7/24 at 8:35am stated that on 7/29/24 at 10:00am, staff S1 pinched child C1 because C1 had pinched another child while eating snack outside, and that S1 grabbed child C2 by the shoulders and moved them roughly. Director stated that S1 was observed by S2 pinching C1 and roughly handling C2, and that S1 was observed handling C2 in a rough manner on camera.

One of staff (S2) was interviewed on 7/30/24 and stated that S2 witnessed S1 pinch C1 because C1 had pinched another child. S2 also stated that S2 asked S1 to move child C2 on the blanket and S1 grabbed C2 by the shoulders and moved C2 aggressively.
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Sydney SimsTELEPHONE: (916) 365-5731
LICENSING EVALUATOR SIGNATURE:
DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/30/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3


Document Has Been Signed on 08/13/2024 02:10 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 08/07/2024 08:20 AM

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: KOTASIK DAYCARE
FACILITY NUMBER: 525407977

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/30/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/08/2024
Section Cited
CCR
101223(a)(3)

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This requirement was not met as evidenced by:
The licensee shall ensure that each child is accorded the following personal rights: To be free from corporal or unusual punishment, infliction of pain...
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Director will conduct a staff meeting and discuss appropriate conduct with staff, Director and all staff will watch the CCLD video provided by LPA Sims and write statement acknowledging all staff watched the video and atteneded meeting.
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Based on interviews and information reported the facility did not comply with the section cited above by violating the personal rights of children C1 and C2.
which poses a potential health, safety or personal rights risk to children in care.
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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 AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Sydney SimsTELEPHONE: (916) 365-5731
LICENSING EVALUATOR SIGNATURE:
DATE: 07/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/30/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3


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: KOTASIK DAYCARE
FACILITY NUMBER: 525407977
VISIT DATE: 07/30/2024
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LPA Sims informed facility representative Jessie Radcliff report dated 7/30/24 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.

LPA Sims informed the facility representative to provide a copy of this licensing report dated 7/30/24 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.



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

Based on interviews and information reported the following deficiency is being cited on the LIC809-D: 1012239(a)(3) The licensee shall ensure that each child is accorded the following personal rights: To be free from corporal or unusual punishment, infliction of pain...

Exit interview conducted and report was reviewed with the facility representative Jessie Radcliff. Appeal Rights were provided.
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Sydney SimsTELEPHONE: (916) 365-5731
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024
LIC809 (FAS) - (06/04)
Page: 3 of 3