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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 181372519
Report Date: 03/04/2026
Date Signed: 03/04/2026 04:29:51 PM

Document Has Been Signed on 03/04/2026 04:29 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 CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:SUSANVILLE HEAD STARTFACILITY NUMBER:
181372519
ADMINISTRATOR/
DIRECTOR:		SWAIN, NICOLETTEFACILITY TYPE:
850
ADDRESS:195 RUSSELL AVETELEPHONE:
(530) 257-2343
CITY:SUSANVILLESTATE: CAZIP CODE:
96130
CAPACITY: 28TOTAL ENROLLED CHILDREN: 28CENSUS: 12DATE:
03/04/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:46 PM
MET WITH:Mayra Puente - Site SupervisorTIME VISIT/
INSPECTION COMPLETED:
04:40 PM
NARRATIVE
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An unannounced case management inspection was conducted today at 1:46pm by Licensing Program Analyst (LPA), Sydney Sims. LPA met with Site Supervisor Mayra Puente. In response to an unusual incident report received by the department on 02/05/26 where there was an inappropriate interaction between child C1 and C2.

The Site Supervisor was interviewed on 03/04/26 and stated that on 1/30/26 at 11:38am that there was an inappropriate interaction between C1 and C2 that occurred during the transition between the classroom to the lunch room when C1 and C2 were left alone in the hallway without staff supervision for 18 seconds.

Two Staff (S1 -S2) were interviewed on 03/04/26 and S1 stated that S1 walked into the interaction between C1 and C2 and stated that C1 was touching C2 in an inappropriate manner over the clothes. S1 stated that the children were alone in the hallway with out supervision when the interaction occurred but that S1 separated the children as soon as S1 observed the incident occurring. S2 stated that S2 was in the lunchroom with the other children when the incident occurred and that S2 did not observe the incident.
NAME OF LICENSING PROGRAM MANAGER: Megan Aviles
NAME OF LICENSING PROGRAM ANALYST: Sydney Sims
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/04/2026
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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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)
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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 CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: SUSANVILLE HEAD START
FACILITY NUMBER: 181372519
VISIT DATE: 03/04/2026
NARRATIVE
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While reviewing camera footage from the classroom, LPA Sims observed that at 11:38pm Staff S1 walks C1 and C2 over to the hallway between the lunch room and the classroom and then turns around and walks back into the classroom to the far side and grabs clothes. S1 then walks backs towards the hallway and finds children C1 and C2 in the hallways engaged in an inappropriate interaction. The children were left unsupervised in the hallway for 18 seconds.

In addition during the video at 11:39pm S1 is observed on camera pulling C1 by the arm in a rough manner into the classroom and yelling at C1 to "sit down right now". S1 then sits C1 down on the carpet and yells at the child, with S1 stating that " I am so angry" at C1.

During today’s inspection, the facility was toured, interviews were conducted with staff, and video footage was reviewed. Based on interviews and video footage LPA observed that an inappropriate interaction between children C1 - C2 occurred during a lack of supervision from the facility staff and that S1 handled child C1 in a rough manner.

Based on interview and video footage review the following deficiency is being cited on the LIC809-D: 101229(a)(1), 101223(a)(3)
NAME OF LICENSING PROGRAM MANAGER: Megan Aviles
NAME OF LICENSING PROGRAM ANALYST: Sydney Sims
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2026
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 CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: SUSANVILLE HEAD START
FACILITY NUMBER: 181372519
VISIT DATE: 03/04/2026
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LPA Sims informed the Site Supervisor Mayra Puente that this report dated 03/04/26 documents two Type A citation(s) 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 site Supervisor to provide a copy of this licensing report dated 03/04/26 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 Site Supervisor Mayra Puente. Appeal Rights were provided. A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.


NAME OF LICENSING PROGRAM MANAGER: Megan Aviles
NAME OF LICENSING PROGRAM ANALYST: Sydney Sims
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 03/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/04/2026 04:29 PM - It Cannot Be Edited


Created By: Sydney Sims On 03/04/2026 at 04:02 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: SUSANVILLE HEAD START
FACILITY NUMBER: 181372519

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/04/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/05/2026
Section Cited
CCR
101229(a)(1)

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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.
This requirment was not met as evidence by:
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Site Supervisor will hold an all staff meeting and review supervision and transtition regulations. All staff are to sign statement that they were in attendance and that staff understand and agree to follow to the regualtions. POC to be email to LPA Sims by 03/05/26 to sydney.sims@dss.ca.gov
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Based on observation of video footage and interview the licensee did not comply with the section cited above by C1 and C2 being unsupervised for 18 seconds resulting in a innapropriate interaction which poses an immediate health, safety or personal rights risk to children in care
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Type A
03/05/2026
Section Cited
CCR101223(a)(3)

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To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse or other actions of a punitive nature...

This requirment was not met as evidence by:
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Site Supervisor will hold all staff meeting and review the perosonal rights video provided and review Personal rights regulation. Staff are to sign statement that they were in attendance and that staff understand and agree to follow to the regualtions. POC to be emailed by 03/05/26 to sydney.sims@dss.ca.gov
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Based on observation of video footage and interview the licensee did not comply with the section cited above by staff S1 handling child C1 in a rough manner which poses an immediate 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.
Megan Aviles
NAME OF LICENSING PROGRAM MANAGER:
Sydney Sims
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 03/04/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/04/2026


LIC809 (FAS) - (06/04)
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