525407390-3-26-2026-13-CC-SSIS-DSJUGR-20260326153446

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 525407390
Report Date: 03/26/2026
Date Signed: 03/26/2026 03:34:55 PM

Document Has Been Signed on 03/26/2026 03:34 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:	ROOM TO BLOOM EARLY HEAD START		FACILITY NUMBER:	525407390
ADMINISTRATOR/ DIRECTOR:	HERNANDEZ, ROSEMARY		FACILITY TYPE:	830
ADDRESS:	1050 KIMBALL ROAD		TELEPHONE:	(530) 529-1500
CITY:	RED BLUFF	STATE: CA	ZIP CODE:	96080
CAPACITY: 19	TOTAL ENROLLED CHILDREN: 19	CENSUS: 9	DATE:	03/26/2026
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:00 PM
MET WITH:	Rosemary Hernandez		TIME VISIT/ INSPECTION COMPLETED:	03:45 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	An unannounced case management inspection was conducted today at 2:00pm by Licensing Program Analyst (LPA), Sydney Sims. LPA met with Site Supervisor Rosemary Hernandez. In response to an unusual incident report received by the department on 03/13/26 where child C1 fell of a bench and hit their head and emergency services were called to the facility. The Site Supervisor was interviewed on 03/26/26 at 2:20pm and stated that on 03/10/26 at 10:00am the Site Supervisor did not observe the incident but to their knowledge, Staff S1 - S3 had taken the children on a walk down the street to the community center for a nature walk and birthday celebration. While at the community center the staff sat a few of the children on the park bench to take a photo and child C1 was on the edge of the bench and reached over for a cupcake and fell off the side of the bench hitting C1's head on the ground. Staff S2 provided ice for C1 and rushed C1 back to the facility. Upon arrival to the facility site supervisor observed that C1 started falling asleep and was not responding to prompts so the site supervisor called 911 and C1's parents. Emergency medical services came to the facility and evaluated C1 and cleared C1 of any injuries and C1 did not receive any further medical attention.

NAME OF LICENSING PROGRAM MANAGER: Megan Aviles
NAME OF LICENSING PROGRAM ANALYST: Sydney Sims
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 03/26/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2026

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: ROOM TO BLOOM EARLY HEAD START	FACILITY NUMBER: 525407390
	VISIT DATE: 03/26/2026

NARRATIVE

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One parent (P1) was interviewed on 03/26/26 and had knowledge of the incident stating that C1 did receive emergency medical services at the facility but that the paramedics cleared C1 of any injuries and stated that C1's vitals were good. P1 stated the no further medical attention was required. C1 had not concerns about the injury.

Three Staff (S1 -S3) were interviewed on 03/26/26 and stated that S1 - S3 were present at the time of the incident. S2 stated that S2 did not observe C1 fall as S2 was attending to other children. S1 and S3 stated that C1 was sitting on the bench with S1 standing behind the bench holding onto C1 and C1 reached over to grab a cupcake and fell off the side of the bench. S1 stated that S1 grabbed ice for C1 and rushed C1 over to the facility where C1 then began falling asleep and was not responding to prompts so emergency medical services were called.

During today’s inspection, the facility was toured, and interviews were conducted with staff and parent, supporting the incident report filed by the facility.

Although child C1 did sustain an injury while in care at the facility it could not be determined that a regulation violation occurred.

Exit interview conducted and report was reviewed with the site supervisor Rosemary Hernandez. 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: 03/26/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2026

LIC809 (FAS) - (06/04)

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