<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 125406606
Report Date: 08/06/2025
Date Signed: 08/06/2025 12:23:17 PM

Document Has Been Signed on 08/06/2025 12:23 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:SURBAUGH, NINA FAMILY CHILD CARE HOMEFACILITY NUMBER:
125406606
ADMINISTRATOR/
DIRECTOR:		SURBAUGH, NINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 832-6327
CITY:MCKINLEYVILLESTATE: CAZIP CODE:
95519
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
08/06/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:15 AM
MET WITH:Meaghan TalkingtonTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
LPA Lynch visited the home for the purpose of a follow-up case management visit regarding a self-reported incident initially reported on 02/05/25. Licensee reported that during a transition period, there was a lapse in supervision and an approximately 20 month old toddler went into the nap room and climbed into a play yard where an approximately 12 month old infant was sleeping, and was there approximately three to five minutes before child was discovered by staff quietly laying and resting next to infant, and removed from play yard and room. Licensee stated the infant was picked up, held, and rocked by staff and put back to sleep in the darkened nap room. Licensee stated at the next transitional period approximately one hour later, staff opened the curtains in the nap room and saw several scratches and bruises on infant's face and child seemed fussy and groggy, but seemed responsive and did not seem in distress. Licensee stated she contacted 911 out of an abundance of caution, and the parents and went with child to the doctor, and it was revealed child had superficial scratches and bruises and was allowed to come home after a two hour watch period. Licensee stated she had meetings with both sets of parents, and both children came back to care after the incident. LPA also conducted interviews with both assistants and infant's parents,
NAME OF LICENSING PROGRAM MANAGER: Erin Virrueta
NAME OF LICENSING PROGRAM ANALYST: Kiriko Lynch
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/06/2025
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 4
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
Page: 2 of 4
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: SURBAUGH, NINA FAMILY CHILD CARE HOME
FACILITY NUMBER: 125406606
VISIT DATE: 08/06/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
and details of incident were corroborated. LPA reviewed the nap log and found infant was checked every 15 minutes during the nap period.

Based on interviews and records review, LPA found there was a lapse of supervision by staff during a transition period which allowed a child to climb into an infant's play yard during nap time for a period of approximately three to five minutes and infant sustained minor injuries. The following deficiency is being cited on the LIC809-D.

Exit interview conducted and report was reviewed with the facility representative Meaghan Talkington. Notice of site visit posted and appeal rights were provided.
NAME OF LICENSING PROGRAM MANAGER: Erin Virrueta
NAME OF LICENSING PROGRAM ANALYST: Kiriko Lynch
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 08/06/2025 12:23 PM - It Cannot Be Edited


Created By: Kiriko Lynch On 08/06/2025 at 12:07 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: SURBAUGH, NINA FAMILY CHILD CARE HOME
FACILITY NUMBER: 125406606

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/06/2025
Section Cited
CCR
102423

1
2
3
4
5
6
7
Personal Rights - (a) Each child receiving services from a family child care home shall have certain rights...These rights include, but
are not limited to, the following:
(2) To receive safe, healthful, and comfortable accommodations, furnishings, and equipment.
1
2
3
4
5
6
7
Licensee stated she implemented enhanced supervision procedures during transitions and also re-installed baby gate to hallway entry to nap room, and provided proof to LPA at time of initial visit and via email. POC cleared at time of visit.
8
9
10
11
12
13
14
This requirement was not met as evidenced by staff did not adequately supervise toddler child during a transition period resulting in minor injuries to an infant child in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Erin Virrueta
NAME OF LICENSING PROGRAM MANAGER:
Kiriko Lynch
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/06/2025


LIC809 (FAS) - (06/04)
Page: 4 of 4