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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 511300358
Report Date: 11/13/2024
Date Signed: 11/13/2024 12:07:31 PM

Document Has Been Signed on 11/13/2024 12:07 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:JACK AND JILL PLAYSCHOOLFACILITY NUMBER:
511300358
ADMINISTRATOR/
DIRECTOR:
MCINTIRE, ALISSAFACILITY TYPE:
850
ADDRESS:1122 FRANKLIN ROADTELEPHONE:
(530) 673-5539
CITY:YUBA CITYSTATE: CAZIP CODE:
95991
CAPACITY: 25TOTAL ENROLLED CHILDREN: 25CENSUS: 23DATE:
11/13/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:50 AM
MET WITH:Alissa McIntireTIME VISIT/
INSPECTION COMPLETED:
12:20 PM
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On 11/13/2024 @ 11:50am, an unannounced case management inspection was conducted by Licensing Program Analyst (LPA), Elizabeth Friese. LPA Friese met with Director Alissa McIntire in response to an unusual incident which was self-reported to the Department on 11/12/24.

The Director reported that on 11/07/24, a child (C1) was having a meltdown, kicking and swinging. They were removed from the other students to the quiet corner, a padded area with pillows and a beanbag chair. They continued to cry and threw themselves backwards into an area of unpadded wall from a seated position, hitting their head. Staff immediately iced the area, notified their parent and continued to monitor C1 throughout the day at their request. C1 went back to playing within a few minutes and exhibited no signs of concussion.

During this inspection the area where the incident occurred was toured. It was determined that the area is safe for its’ purpose and that C1’s incident was isolated. The director does plan to line the wall of that area with extra rubber mat that they have on-site.

Report was reviewed with facility representative Alissa McIntire, and appeal rights provided.

Notice of site visit to be posted for 30 days.

SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Elizabeth Friese
LICENSING EVALUATOR SIGNATURE: DATE: 11/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/13/2024
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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