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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045407980
Report Date: 02/21/2025
Date Signed: 02/21/2025 12:54:37 PM

Document Has Been Signed on 02/21/2025 12:54 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
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:CREATIVE SCHOLARS ACADEMY PRESCHOOLFACILITY NUMBER:
045407980
ADMINISTRATOR/
DIRECTOR:		RAY, NICOLEFACILITY TYPE:
850
ADDRESS:120 YELLOWSTONE DR.TELEPHONE:
(530) 809-2468
CITY:CHICOSTATE: CAZIP CODE:
95973
CAPACITY: 58TOTAL ENROLLED CHILDREN: 58CENSUS: 31DATE:
02/21/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:41 AM
MET WITH:Bianca SheltonTIME VISIT/
INSPECTION COMPLETED:
01:05 PM
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An unannounced case management inspection was conducted today at 2/21/25 10:41am by Licensing Program Analyst (LPA), Bianca Mendez and Emily Curiel. LPA met with facility representative Bianca Shelton. In response to an Unusual Incident Report received by the Department on 2/12/25, Child (C1) was playing on a play structure outside and jumped off from the play structure and landed on the back of their head requiring medical attention.

The licensee was interviewed on 2/13/25 and stated on 2/12/25 at approximately 4pm child (C1) was playing on a play structure outside. C1 jumped off of it and landed on the back of their head when C1 jumped off. Staff called parent (P1), and P1 took C1 to get medical care. C1 got a cut which required two staples in their head.

SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Bianca Mendez
LICENSING EVALUATOR SIGNATURE: DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2025
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
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: CREATIVE SCHOLARS ACADEMY PRESCHOOL
FACILITY NUMBER: 045407980
VISIT DATE: 02/21/2025
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LPAs interviewed 3 staff on 2/21/25. 3 of 3 staff stated that they did not witness the incident of how child C1 sustained an injury that required medical attention. 2 of 3 staff stated that C1 was playing outside on the school bus play structure and they heard C1 crying. S3 stated that they saw C1 crying and C1 was lying face down near the school bus play structure and went to check on them and picked them up and noticed there was blood on the back of their head and immediately brought C1 inside the classroom. S1 stated they cleaned C1's head wound and they immediately notified the parent (P1) and were unable to reach P1 but was able to go down the list of emergency contacts until P1 was reached. Parent (P1) was interviewed on 2/19/25 and stated that they were immediately notified of the incident but was unable to be reached at that time, P1 stated that they took C1 to the emergency room and C1 had 2 staples on the back of their head. P1 stated they were not aware of how C1 sustained an injury.

LPA interviewed children (C2-C3) on 2/21/25. C2 stated that they were sitting next to C1 on the bus play structure when C1 was hit by a ball and fell down from the bus. C3 stated that C1 was coming down from the bus and there was a ball on the ground and C1 stepped on it, and fell down. C3 showed the corner of the bus that C1 hit their head on.

During today’s inspection, the facility was toured. LPA observed 31 children in care

Based on staff and children interviews, it could not be determined that the incident occurred based off of a lack of supervision.

Exit interview conducted and report was reviewed with the facility representative Bianca Shelton. Appeal Rights were provided.


SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Bianca Mendez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025
LIC809 (FAS) - (06/04)
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