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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455406084
Report Date: 06/24/2024
Date Signed: 06/25/2024 02:37:22 PM

Document Has Been Signed on 06/25/2024 02:37 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:SHASTA HEAD START - LAKE CENTERFACILITY NUMBER:
455406084
ADMINISTRATOR/
DIRECTOR:		WADE, TRACYFACILITY TYPE:
850
ADDRESS:375 LAKE BLVD., SUITE 200TELEPHONE:
(530) 241-1036
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY: 88TOTAL ENROLLED CHILDREN: 88CENSUS: 24DATE:
06/24/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:47 PM
MET WITH:Tracy Wade - Site SupervisorTIME VISIT/
INSPECTION COMPLETED:
02:39 PM
NARRATIVE
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An unannounced case management inspection was conducted today at 1:47pm by Licensing Program Analyst (LPA), Sydney Sims and Tammy Dutra. LPA met with facility representative Tracy Wade. In response to an Unusual Incident Report received by the Department on 5/24/24 were child C1 was left outside with an unqualified staff.

The facility representative was interviewed on 6/24/24 at 2:00pm and stated that on 5/23/24 at around 12:00pm child C1 was left on the play ground during transition with an unqualified staff from the maintenance department. Facility Representative stated the child was hiding behind some shelves outside and intentionally hiding from staff.

During today’s inspection, the facility was toured and LPA observed 24 children in care.

Based on report received and interviews conducted the following deficiency is being cited on the LIC809-D: 101229(a)(1) 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.


SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Sydney Sims
LICENSING EVALUATOR SIGNATURE: DATE: 06/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/24/2024
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
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: SHASTA HEAD START - LAKE CENTER
FACILITY NUMBER: 455406084
VISIT DATE: 06/24/2024
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LPA informed facility Representative Tracy Wade that this report dated 6/24/24 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.

LPAs Sydney Sims and Tammy Dutra informed the facility representative to provide a copy of this licensing report dated 6/24/24 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.



Exit interview conducted and report was reviewed with the facility representative Tracy Wade. Appeal Rights were provided
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Sydney Sims
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 06/24/2024 02:30 PM - It Cannot Be Edited


Created By: Sydney Sims On 06/24/2024 at 02:12 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: SHASTA HEAD START - LAKE CENTER
FACILITY NUMBER: 455406084

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/24/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/25/2024
Section Cited
CCR
101229(a)(1)

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101229(a)(1)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.
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Facility fired the head teacher of the classroom, Staff did active child supervision zoning training, all staff involved were given write ups. Site supervisor is supervising all current transitions.
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Based on interview and unsual incdent report received, the facility did not comply with the section cited above in 1 count, 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.
SUPERVISOR'S NAME:Megan Aviles
LICENSING EVALUATOR NAME:Sydney Sims
LICENSING EVALUATOR SIGNATURE:
DATE: 06/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/24/2024


LIC809 (FAS) - (06/04)
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