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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 573614795
Report Date: 02/11/2025
Date Signed: 02/11/2025 02:06:25 PM

Document Has Been Signed on 02/11/2025 02:06 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
SACRAMENTO SOUTH, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:WOODLAND JOINT USD - MAXWELLFACILITY NUMBER:
573614795
ADMINISTRATOR/
DIRECTOR:		MARISOL ARRIAGAFACILITY TYPE:
850
ADDRESS:50 ASHLEY AVENUETELEPHONE:
(530) 662-1784
CITY:WOODLANDSTATE: CAZIP CODE:
95695
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 23DATE:
02/11/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Maria LewisTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
NARRATIVE
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On February 11, 2025, Licensing Program Analyst (LPA) Lauren Scott met with Child Development Program Coordinator, Maria Lewis to follow up on an Unusual Incident Report (UIR) that was reported to Community Care Licensing Division (CCLD) on 01/30/2025.

The facility reported the UIR to CCLD within 24 hours and submitted a written UIR within 7 days.

LPA conducted interview and obtained information pertinent to the incident. Through interviews, it was revealed the school district provides a staff to support to students within the classroom. It was also revealed a child in care, was inappropriately disciplined by the district staff member.

Based on the interviews and information obtained, one Title 22 Deficiency has been issued on the attached LIC 809-D. The facility was informed that this report dated 02/11/2025 documents one Type A citation, which shall be posted for 30 consecutive days. The facility shall also provide a copy of this licensing report 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. Facility has been provided with appeal rights.

Exit interview conducted and report was reviewed with Child Development Program Coordinator, Maria Lewis. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Lauren Scott
LICENSING EVALUATOR SIGNATURE: DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/11/2025
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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Document Has Been Signed on 02/11/2025 02:06 PM - It Cannot Be Edited


Created By: Lauren Scott On 02/11/2025 at 01:33 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: WOODLAND JOINT USD - MAXWELL
FACILITY NUMBER: 573614795

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/11/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
02/12/2025
Section Cited
CCR
101223(a)(3)

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(a) The licensee shall ensure that each child is accorded the following personal rights:
(3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation... or other actions of a punitive nature... This requirement was not met as evidenced by:
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Facility will conduct a meeting regarding children's personal rights in regards to discipline. Facility will submit a copy of meeting notes with staff signatures to CCLD by POC date.
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Through interviews, it was revealed one staff employed by the district, physically mishandled a child in care in response to a behavior the child displayed.
This poses an immediate health, safety and/ 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:Chayntel Hunter
LICENSING EVALUATOR NAME:Lauren Scott
LICENSING EVALUATOR SIGNATURE:
DATE: 02/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/11/2025


LIC809 (FAS) - (06/04)
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