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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 455407064
Report Date: 08/20/2021
Date Signed: 08/23/2021 11:03:45 AM

Document Has Been Signed on 08/23/2021 11:03 AM - 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:GREAT ADVENTURESFACILITY NUMBER:
455407064
ADMINISTRATOR:ROBERTS, PATRICIAFACILITY TYPE:
850
ADDRESS:2220 BALLS FERRY ROADTELEPHONE:
(530) 378-5720
CITY:ANDERSONSTATE: CAZIP CODE:
96007
CAPACITY: 30TOTAL ENROLLED CHILDREN: 0CENSUS: 9DATE:
08/20/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Patricia RobertsTIME COMPLETED:
11:40 AM
NARRATIVE
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During an inspection at the facility it was determined that the licensee/ director failed to report an unusual incident on 6/18/21 to Community Care Licensing Division as required. The licensee/director stated that the incident was not reported to CCLD as they were uncertain if the alleged incident needed to be reported. Licensee previously communicated incident with parent and felt that the information was sufficient. Though it is unknown if the actual incident occurred or not, regulation and it is required to report of any suspected incidents of physical or psychological abuse of any child, which includes any suspected child on child abuse. Further, a verbal declaration by a child in care of child on child abuse should be an unusual incident in and of itself.

This report was reviewed and discussed with the licensee.

The following deficiency of the California Code of Regulations, Title 22; Division 12, was observed: see LIC 809D. Appeal Rights were provided. The Notice of Site Visit shall be posted for 30 days.

SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Bianca Mendez
LICENSING EVALUATOR SIGNATURE: DATE: 08/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/20/2021
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 08/23/2021 11:03 AM - It Cannot Be Edited


Created By: Bianca Mendez On 08/20/2021 at 11:29 AM
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: GREAT ADVENTURES
FACILITY NUMBER: 455407064

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/20/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/20/2021
Section Cited
CCR
101212(d)(1)(c)

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CC 101212(d)(1)(c) Reporting requirements
Upon the occurrence, during the operation of the childcare center of any of the events specified in (d)(1) below, a report shall be made to the Department by telephone or fax within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event. Events reported shall include the following: Any unusual incident or child absence that threatens the physical or emotional health or safety of any child.
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The licensee agreed to review section 101212 of Title 22 California Code of Regulations. The licensee agreed to review the section and send an acknowledgment to CCLD and review child care videos by 8/28/21.
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Licensee failed to report an unusual that occurred on 6/18/21 that resulted in a child sustaining unexplained injuries that may have resulted after nap time.
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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:Erin Virrueta
LICENSING EVALUATOR NAME:Bianca Mendez
LICENSING EVALUATOR SIGNATURE:
DATE: 08/20/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/20/2021


LIC809 (FAS) - (06/04)
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